Provider Demographics
NPI:1689104127
Name:MARTINS-ADEKUNLE, ADEBISI
Entity Type:Individual
Prefix:
First Name:ADEBISI
Middle Name:
Last Name:MARTINS-ADEKUNLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 PASEO SERENATA
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8192
Mailing Address - Country:US
Mailing Address - Phone:612-205-8625
Mailing Address - Fax:
Practice Address - Street 1:51 TIERRA REJADA RD
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2902
Practice Address - Country:US
Practice Address - Phone:805-416-5791
Practice Address - Fax:805-416-5792
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist