Provider Demographics
NPI:1508466129
Name:ADEYEMO, ADESUBOMI OLUWADAMILOLA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ADESUBOMI
Middle Name:OLUWADAMILOLA
Last Name:ADEYEMO
Suffix:
Gender:F
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:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:REDAN
Mailing Address - State:GA
Mailing Address - Zip Code:30074-0301
Mailing Address - Country:US
Mailing Address - Phone:678-431-9715
Mailing Address - Fax:
Practice Address - Street 1:98 W WALNUT AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8477
Practice Address - Country:US
Practice Address - Phone:762-209-5045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist