Provider Demographics
NPI:1295395127
Name:YUSUF, OLADEJI ABIMBOLA (RPH)
Entity type:Individual
Prefix:MR
First Name:OLADEJI
Middle Name:ABIMBOLA
Last Name:YUSUF
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 1:10500 VISTA GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4236
Mailing Address - Country:US
Mailing Address - Phone:240-893-6166
Mailing Address - Fax:
Practice Address - Street 1:11466 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3617
Practice Address - Country:US
Practice Address - Phone:240-701-4741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD202153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy