Provider Demographics
NPI:1760771505
Name:BADARU, JUBRIL OLANREWAJU
Entity Type:Individual
Prefix:MR
First Name:JUBRIL
Middle Name:OLANREWAJU
Last Name:BADARU
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 1:5624 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1401
Mailing Address - Country:US
Mailing Address - Phone:410-719-7608
Mailing Address - Fax:410-719-0400
Practice Address - Street 1:5624 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-1401
Practice Address - Country:US
Practice Address - Phone:410-719-7608
Practice Address - Fax:410-719-0400
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist