Provider Demographics
NPI:1790214427
Name:GEORGE, ADEYEMI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ADEYEMI
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 N DAVIS DR STE 1014
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-3240
Mailing Address - Country:US
Mailing Address - Phone:817-538-5251
Mailing Address - Fax:817-538-5252
Practice Address - Street 1:1012 N DAVIS DR STE 1014
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3240
Practice Address - Country:US
Practice Address - Phone:817-538-5251
Practice Address - Fax:817-538-5251
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24760183500000X
TX61733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist