Provider Demographics
NPI:1639385040
Name:ADENUPEBI, ADEBAYO CLEMENT (RPH)
Entity Type:Individual
Prefix:MR
First Name:ADEBAYO
Middle Name:CLEMENT
Last Name:ADENUPEBI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4936 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1440
Mailing Address - Country:US
Mailing Address - Phone:301-345-3400
Mailing Address - Fax:301-345-2444
Practice Address - Street 1:4936 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1440
Practice Address - Country:US
Practice Address - Phone:301-345-3400
Practice Address - Fax:301-345-2444
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5614850001Medicare ID - Type Unspecified