Provider Demographics
NPI:1326447301
Name:ADETULA, IBUKUN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:IBUKUN
Middle Name:
Last Name:ADETULA
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 1:150 E BLOOMINGDALE AVE
Mailing Address - Street 2:SUITE 164
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8151
Mailing Address - Country:US
Mailing Address - Phone:813-360-0528
Mailing Address - Fax:855-771-3086
Practice Address - Street 1:150 E BLOOMINGDALE AVE
Practice Address - Street 2:SUITE 164
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8151
Practice Address - Country:US
Practice Address - Phone:813-360-0528
Practice Address - Fax:855-771-3086
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist