Provider Demographics
NPI:1235756503
Name:BADERO, OMOLADE M (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:OMOLADE
Middle Name:M
Last Name:BADERO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3718 JEFFERSON COMMONS DR APT 301
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-6481
Mailing Address - Country:US
Mailing Address - Phone:615-275-6578
Mailing Address - Fax:
Practice Address - Street 1:3718 JEFFERSON COMMONS DR APT 301
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-6481
Practice Address - Country:US
Practice Address - Phone:615-275-6578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1235314OtherNOT SURE