Provider Demographics
NPI:1013574094
Name:ABIODUN, MODINAT FADEKE (PHARM D)
Entity Type:Individual
Prefix:
First Name:MODINAT
Middle Name:FADEKE
Last Name:ABIODUN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 TOM HALL ST
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7000
Mailing Address - Country:US
Mailing Address - Phone:803-548-4699
Mailing Address - Fax:
Practice Address - Street 1:1250 TOM HALL ST
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7000
Practice Address - Country:US
Practice Address - Phone:803-548-4699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist