Provider Demographics
NPI:1629425764
Name:OBADEYI, ABAYOMI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ABAYOMI
Middle Name:
Last Name:OBADEYI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6235 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-3719
Mailing Address - Country:US
Mailing Address - Phone:310-720-5331
Mailing Address - Fax:661-943-9482
Practice Address - Street 1:1122 N BRAND BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2547
Practice Address - Country:US
Practice Address - Phone:818-244-3164
Practice Address - Fax:818-244-8615
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 57546183500000X
ORRPH-0006343183500000X
TN27443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist