Provider Demographics
NPI:1407185317
Name:ALABA, ADE KANMBI (RPH)
Entity Type:Individual
Prefix:
First Name:ADE
Middle Name:KANMBI
Last Name:ALABA
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 1:1438 GULF TO BAY BLVD
Mailing Address - Street 2:P.O.BOX 6502
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-5341
Mailing Address - Country:US
Mailing Address - Phone:727-441-8361
Mailing Address - Fax:727-441-8361
Practice Address - Street 1:1438 GULF-TO-BAY BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755
Practice Address - Country:US
Practice Address - Phone:727-441-8361
Practice Address - Fax:727-441-8361
Is Sole Proprietor?:No
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist