Provider Demographics
NPI:1629352539
Name:FADESERE, JANE TEMITOPE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:TEMITOPE
Last Name:FADESERE
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 1:5300 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-1726
Mailing Address - Country:US
Mailing Address - Phone:504-456-4851
Mailing Address - Fax:
Practice Address - Street 1:3535 SEVERN AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3482
Practice Address - Country:US
Practice Address - Phone:504-456-4851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18643183500000X
TX47232183500000X
MD17798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist