Provider Demographics
NPI:1043719958
Name:FASAN, ADENIKE (BPHARM)
Entity Type:Individual
Prefix:MRS
First Name:ADENIKE
Middle Name:
Last Name:FASAN
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:ADENIKE
Other - Middle Name:
Other - Last Name:AKINBOWALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BPHARM
Mailing Address - Street 1:1504 HUGH FOREST RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-9797
Mailing Address - Country:US
Mailing Address - Phone:980-442-9304
Mailing Address - Fax:
Practice Address - Street 1:4525 CAMERON VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4369
Practice Address - Country:US
Practice Address - Phone:980-442-9304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC239601835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology