Provider Demographics
NPI:1124399480
Name:ADENIRAN, ADEBAYO (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADEBAYO
Middle Name:
Last Name:ADENIRAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 WOODLAND AVE # 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-4433
Mailing Address - Country:US
Mailing Address - Phone:215-883-0568
Mailing Address - Fax:
Practice Address - Street 1:4835 WOODLAND AVE # 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-4433
Practice Address - Country:US
Practice Address - Phone:215-883-0568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102796244Medicaid