Provider Demographics
NPI:1083937825
Name:WIDLAK, ADEDAYO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ADEDAYO
Middle Name:
Last Name:WIDLAK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ADEDAYO
Other - Middle Name:
Other - Last Name:ADEROJU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:163 LEDGEWOOD RD APT 412
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6612
Mailing Address - Country:US
Mailing Address - Phone:575-921-2492
Mailing Address - Fax:
Practice Address - Street 1:441 LONG HILL RD
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4149
Practice Address - Country:US
Practice Address - Phone:860-405-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0011214183500000X
NMRP00006715183500000X
GARPH024999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist