Provider Demographics
NPI:1205488699
Name:ADEYEMO, MICHAEL AFOLABI (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:AFOLABI
Last Name:ADEYEMO
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 1:122 N ALAMO RD STE 3
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-2215
Mailing Address - Country:US
Mailing Address - Phone:956-685-1050
Mailing Address - Fax:956-685-1060
Practice Address - Street 1:122 N ALAMO RD STE 3
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-2215
Practice Address - Country:US
Practice Address - Phone:956-685-1050
Practice Address - Fax:956-685-1060
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist