Provider Demographics
NPI:1205542164
Name:BUSARI, AKEEM ADEMOLA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:AKEEM
Middle Name:ADEMOLA
Last Name:BUSARI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WINTER ST APT C08
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-5096
Mailing Address - Country:US
Mailing Address - Phone:312-647-3128
Mailing Address - Fax:
Practice Address - Street 1:52 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:VT
Practice Address - Zip Code:05089-1308
Practice Address - Country:US
Practice Address - Phone:603-327-6113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0330134864183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist