Provider Demographics
NPI:1881872232
Name:FALODUN, ADEBAYO ANTHONY (RPH)
Entity type:Individual
Prefix:MR
First Name:ADEBAYO
Middle Name:ANTHONY
Last Name:FALODUN
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 1:37 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-3001
Mailing Address - Country:US
Mailing Address - Phone:212-425-8460
Mailing Address - Fax:212-269-5259
Practice Address - Street 1:37 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-3001
Practice Address - Country:US
Practice Address - Phone:212-425-8460
Practice Address - Fax:212-269-5259
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01540638OtherMMIS