Provider Demographics
NPI:1790005247
Name:ADEFIRANYE, ADESOLA B
Entity Type:Individual
Prefix:
First Name:ADESOLA
Middle Name:B
Last Name:ADEFIRANYE
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 1:677 CROSS KEYS RD
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-9564
Mailing Address - Country:US
Mailing Address - Phone:856-629-0690
Mailing Address - Fax:856-629-7193
Practice Address - Street 1:677 CROSS KEYS RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-9564
Practice Address - Country:US
Practice Address - Phone:856-629-0690
Practice Address - Fax:856-629-7193
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02822300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist