Provider Demographics
NPI:1134729189
Name:ALADEJEBI, ANNA-MAUREEN (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:ANNA-MAUREEN
Middle Name:
Last Name:ALADEJEBI
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:ALADEJEBI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 PAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-2115
Mailing Address - Country:US
Mailing Address - Phone:317-201-1438
Mailing Address - Fax:
Practice Address - Street 1:4205 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-3800
Practice Address - Country:US
Practice Address - Phone:765-446-1278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022186A1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care