Provider Demographics
NPI:1821085283
Name:ADEYEFA, OLAWANDE JOSHUA (RPH)
Entity Type:Individual
Prefix:
First Name:OLAWANDE
Middle Name:JOSHUA
Last Name:ADEYEFA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12153 DICKSON RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-1541
Mailing Address - Country:US
Mailing Address - Phone:678-479-8841
Mailing Address - Fax:
Practice Address - Street 1:GRADY HEALTH SYSTEMS
Practice Address - Street 2:80 JESSE HILL JR DR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-616-4117
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist