Provider Demographics
NPI:1790968626
Name:JOHNSON, FOLASADE ADEYEMI (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:FOLASADE
Middle Name:ADEYEMI
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 E 88TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4915
Mailing Address - Country:US
Mailing Address - Phone:347-702-6196
Mailing Address - Fax:
Practice Address - Street 1:1679 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-2601
Practice Address - Country:US
Practice Address - Phone:718-282-7476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01692066Medicaid