Provider Demographics
NPI:1760620603
Name:SHOWOLE ADENIJI, AJJOKE O
Entity Type:Individual
Prefix:MS
First Name:AJJOKE
Middle Name:O
Last Name:SHOWOLE ADENIJI
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 1:9304 FOREST LN STE 268
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-6247
Mailing Address - Country:US
Mailing Address - Phone:469-223-3992
Mailing Address - Fax:
Practice Address - Street 1:9304 FOREST LN STE 268
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6247
Practice Address - Country:US
Practice Address - Phone:469-223-3992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0106991332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies