Provider Demographics
NPI:1598011488
Name:BAMITEKO, ABISOLA KEMI (PHARMD)
Entity Type:Individual
Prefix:
First Name:ABISOLA
Middle Name:KEMI
Last Name:BAMITEKO
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 1:12059 5TH AVE
Mailing Address - Street 2:APT. B
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-1161
Mailing Address - Country:US
Mailing Address - Phone:917-309-0620
Mailing Address - Fax:
Practice Address - Street 1:1 N LEXINGTON AVE
Practice Address - Street 2:12TH FLOOR
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1712
Practice Address - Country:US
Practice Address - Phone:914-288-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-28
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049997-1183500000X
NJ28RI03206600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist