Provider Demographics
NPI:1700113065
Name:ONITOLO, ADEBISI T (RPH)
Entity type:Individual
Prefix:MS
First Name:ADEBISI
Middle Name:T
Last Name:ONITOLO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 MATLOCK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2527
Mailing Address - Country:US
Mailing Address - Phone:817-617-3598
Mailing Address - Fax:817-617-3619
Practice Address - Street 1:2625 MATLOCK RD STE 102
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2527
Practice Address - Country:US
Practice Address - Phone:817-617-3598
Practice Address - Fax:817-617-3619
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2018-10-15
Deactivation Date:2018-10-01
Deactivation Code:
Reactivation Date:2018-10-15
Provider Licenses
StateLicense IDTaxonomies
TX47144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist