Provider Demographics
NPI:1295954626
Name:ADESANYA, EMMANUEL O (PHARMD)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:O
Last Name:ADESANYA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7507 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-6319
Mailing Address - Country:US
Mailing Address - Phone:240-688-3379
Mailing Address - Fax:
Practice Address - Street 1:1005 BAY RIDGE AVE
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-3031
Practice Address - Country:US
Practice Address - Phone:410-267-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist