Provider Demographics
NPI:1760996367
Name:TOMETI, ADEKUNLE (RPH)
Entity Type:Individual
Prefix:MR
First Name:ADEKUNLE
Middle Name:
Last Name:TOMETI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S COCKRELL HILL RD STE 188
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-2633
Mailing Address - Country:US
Mailing Address - Phone:972-294-9552
Mailing Address - Fax:972-283-6020
Practice Address - Street 1:700 S COCKRELL HILL RD STE 188
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2633
Practice Address - Country:US
Practice Address - Phone:972-294-9552
Practice Address - Fax:972-283-6020
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX39041OtherPHARMACIST LICENSE