Provider Demographics
NPI:1720690985
Name:ADETORO, BABATUNDE A (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:BABATUNDE
Middle Name:A
Last Name:ADETORO
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 1:100 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:TX
Mailing Address - Zip Code:75791-3523
Mailing Address - Country:US
Mailing Address - Phone:903-839-6274
Mailing Address - Fax:
Practice Address - Street 1:2626 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3533
Practice Address - Country:US
Practice Address - Phone:903-531-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist