Provider Demographics
NPI:1942893052
Name:EADES, MABINTOU (PHARMD)
Entity Type:Individual
Prefix:
First Name:MABINTOU
Middle Name:
Last Name:EADES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BINTOU
Other - Middle Name:
Other - Last Name:EADES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:778 TRICOLOR DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-4752
Mailing Address - Country:US
Mailing Address - Phone:479-877-5412
Mailing Address - Fax:
Practice Address - Street 1:3900 MORSE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3016
Practice Address - Country:US
Practice Address - Phone:479-877-5412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208241183500000X
OH03438542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist