Provider Demographics
NPI:1780852947
Name:ADEDAYO, OLUFUNMILAYO IYABODE
Entity Type:Individual
Prefix:
First Name:OLUFUNMILAYO
Middle Name:IYABODE
Last Name:ADEDAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FUNMI
Other - Middle Name:IYABODE
Other - Last Name:ADEDAYO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:9404 JODALE RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-2823
Mailing Address - Country:US
Mailing Address - Phone:410-496-2862
Mailing Address - Fax:
Practice Address - Street 1:9404 JODALE RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-2823
Practice Address - Country:US
Practice Address - Phone:410-496-2862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist