Provider Demographics
NPI:1104852607
Name:PADEK HEALTHCARE INC.
Entity Type:Organization
Organization Name:PADEK HEALTHCARE INC.
Other - Org Name:PADEK HEALTHCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRINCE
Authorized Official - Middle Name:AYODELE
Authorized Official - Last Name:ADEKOYA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:301-277-7107
Mailing Address - Street 1:5403A ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-2201
Mailing Address - Country:US
Mailing Address - Phone:301-277-7107
Mailing Address - Fax:301-277-7127
Practice Address - Street 1:5403A ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-2201
Practice Address - Country:US
Practice Address - Phone:301-277-7107
Practice Address - Fax:301-277-7127
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PADEK HEALTHCARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-25
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP04314332B00000X, 333600000X, 3336C0003X, 3336C0004X, 3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037024500Medicaid
MD420075600Medicaid
MD420053500Medicaid
MD6169320001Medicare NSC