Provider Demographics
NPI:1003373259
Name:ADEGBOYEGA, OLUWAFEMI
Entity Type:Individual
Prefix:
First Name:OLUWAFEMI
Middle Name:
Last Name:ADEGBOYEGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 LAWRENCE RD # APTG11
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-1703
Mailing Address - Country:US
Mailing Address - Phone:708-945-0269
Mailing Address - Fax:
Practice Address - Street 1:1925 LAWRENCE RD # APTG11
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-1703
Practice Address - Country:US
Practice Address - Phone:708-945-0269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP451292OtherPENNSYLVANIA BOARD OF PHARMACY