Provider Demographics
NPI:1295018695
Name:ADEWUMI, RILWAN A (RPH)
Entity Type:Individual
Prefix:
First Name:RILWAN
Middle Name:A
Last Name:ADEWUMI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2266 BIRMINGHAM DR
Mailing Address - Street 2:BELLEVILLE
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-7996
Mailing Address - Country:US
Mailing Address - Phone:618-416-1644
Mailing Address - Fax:
Practice Address - Street 1:5939 BELLEVILLE CROSSING ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-3107
Practice Address - Country:US
Practice Address - Phone:618-355-7913
Practice Address - Fax:618-355-9171
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051293961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist