Provider Demographics
NPI:1700435088
Name:ADEBAYO, DAMILOLA REBECCA
Entity Type:Individual
Prefix:
First Name:DAMILOLA
Middle Name:REBECCA
Last Name:ADEBAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9420 LANHAM SEVERN RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2642
Mailing Address - Country:US
Mailing Address - Phone:301-577-5555
Mailing Address - Fax:
Practice Address - Street 1:9420 LANHAM SEVERN RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2642
Practice Address - Country:US
Practice Address - Phone:301-577-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist