Provider Demographics
NPI:1912206822
Name:BOATIN, ADEDOYIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ADEDOYIN
Middle Name:
Last Name:BOATIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5569 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-1500
Mailing Address - Country:US
Mailing Address - Phone:404-874-0640
Mailing Address - Fax:
Practice Address - Street 1:891 PONCE DE LEON AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-4267
Practice Address - Country:US
Practice Address - Phone:404-874-0640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist