Provider Demographics
NPI:1497193833
Name:ADEBAYO, CLEMENT ADEBOYE
Entity Type:Individual
Prefix:MR
First Name:CLEMENT
Middle Name:ADEBOYE
Last Name:ADEBAYO
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 1:401 EAST PATAPSCO AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MD
Mailing Address - Zip Code:21225
Mailing Address - Country:US
Mailing Address - Phone:410-355-1934
Mailing Address - Fax:410-355-1935
Practice Address - Street 1:401 E PATAPSCO AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MD
Practice Address - Zip Code:21225-1829
Practice Address - Country:US
Practice Address - Phone:410-355-1934
Practice Address - Fax:410-355-1935
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20222183500000X
DCPH100001116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist