Provider Demographics
NPI:1811592835
Name:POPOOLA, ADENIKE OMOTUNDE
Entity Type:Individual
Prefix:MRS
First Name:ADENIKE
Middle Name:OMOTUNDE
Last Name:POPOOLA
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 1:14401 DOLBROOK LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3219
Mailing Address - Country:US
Mailing Address - Phone:301-275-8145
Mailing Address - Fax:301-218-3335
Practice Address - Street 1:2129 14TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4411
Practice Address - Country:US
Practice Address - Phone:202-299-0138
Practice Address - Fax:202-299-0138
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH2870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist