Provider Demographics
NPI:1629672134
Name:ADENIYI, ADEBISI (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADEBISI
Middle Name:
Last Name:ADENIYI
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 1:204 JAMES FOREST CT
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-1479
Mailing Address - Country:US
Mailing Address - Phone:678-613-2826
Mailing Address - Fax:
Practice Address - Street 1:5384 HIGHWAY 20 S
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-4403
Practice Address - Country:US
Practice Address - Phone:770-788-6566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist