Provider Demographics
NPI:1346028545
Name:ADEYEMI, OLUWAMAYOKUN EMMANUEL
Entity Type:Individual
Prefix:
First Name:OLUWAMAYOKUN
Middle Name:EMMANUEL
Last Name:ADEYEMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 MESA LOOP
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2618
Mailing Address - Country:US
Mailing Address - Phone:301-332-5599
Mailing Address - Fax:
Practice Address - Street 1:2070 W OAKLAWN RD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-4607
Practice Address - Country:US
Practice Address - Phone:830-569-3289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist