Provider Demographics
NPI:1710335088
Name:ADEBOLU, OLUJOBA
Entity Type:Individual
Prefix:MR
First Name:OLUJOBA
Middle Name:
Last Name:ADEBOLU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 UTOPIA PKWY
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:214-775-0206
Mailing Address - Fax:
Practice Address - Street 1:18230 TUDOR RD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1510
Practice Address - Country:US
Practice Address - Phone:215-870-7336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183700000X
TX59987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No183500000XPharmacy Service ProvidersPharmacist