Provider Demographics
NPI:1518620012
Name:ADELEKE, KUDIRAT FUNMILAYO
Entity Type:Individual
Prefix:
First Name:KUDIRAT
Middle Name:FUNMILAYO
Last Name:ADELEKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 BERGEN AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5393
Mailing Address - Country:US
Mailing Address - Phone:646-410-3357
Mailing Address - Fax:
Practice Address - Street 1:327 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-9426
Practice Address - Country:US
Practice Address - Phone:908-686-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04157000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI04157000OtherLICENSE