Provider Demographics
NPI:1114528239
Name:ADENIKINJU, OMOLARA ADEWUNMI
Entity Type:Individual
Prefix:
First Name:OMOLARA
Middle Name:ADEWUNMI
Last Name:ADENIKINJU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10515 GREENBELT RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2213
Mailing Address - Country:US
Mailing Address - Phone:301-666-1181
Mailing Address - Fax:844-411-6304
Practice Address - Street 1:10515 GREENBELT RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2213
Practice Address - Country:US
Practice Address - Phone:301-666-1181
Practice Address - Fax:844-411-6304
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPH14485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist