Provider Demographics
NPI:1235603291
Name:DEMMY'S PHARMACY LLC
Entity Type:Organization
Organization Name:DEMMY'S PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEOLU
Authorized Official - Middle Name:TOPE
Authorized Official - Last Name:ODEWALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-220-3124
Mailing Address - Street 1:9 MISTY MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3353
Mailing Address - Country:US
Mailing Address - Phone:301-220-3124
Mailing Address - Fax:
Practice Address - Street 1:5510 CHERRYWOOD LN STE B
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1045
Practice Address - Country:US
Practice Address - Phone:301-220-3124
Practice Address - Fax:301-220-1738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-13
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD593407900Medicaid