Provider Demographics
NPI:1154441459
Name:ADEBAMIRO, ADEBOLA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ADEBOLA
Middle Name:
Last Name:ADEBAMIRO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 LEITH RD # A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-3303
Mailing Address - Country:US
Mailing Address - Phone:267-218-0877
Mailing Address - Fax:
Practice Address - Street 1:5204 LEITH RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-3505
Practice Address - Country:US
Practice Address - Phone:267-218-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist