Provider Demographics
NPI:1942509716
Name:FADIRAN, EMMANUEL OLUTAYO (RPH, PHD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:OLUTAYO
Last Name:FADIRAN
Suffix:
Gender:M
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MENTMORE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2541
Mailing Address - Country:US
Mailing Address - Phone:301-512-0157
Mailing Address - Fax:
Practice Address - Street 1:1521 HARFORD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-5705
Practice Address - Country:US
Practice Address - Phone:410-962-5541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-19
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist