Provider Demographics
NPI:1730456526
Name:ADEYEMI, /RAPHAEL OLORUNLEKE
Entity Type:Individual
Prefix:
First Name:/RAPHAEL
Middle Name:OLORUNLEKE
Last Name:ADEYEMI
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 1:3950 N DEAN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-5144
Mailing Address - Country:US
Mailing Address - Phone:407-681-6366
Mailing Address - Fax:407-681-6359
Practice Address - Street 1:3950 N DEAN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-5144
Practice Address - Country:US
Practice Address - Phone:407-681-6366
Practice Address - Fax:407-681-6359
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23577183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist