Provider Demographics
NPI:1912226630
Name:ADEWODU, FEYI (RPH)
Entity Type:Individual
Prefix:
First Name:FEYI
Middle Name:
Last Name:ADEWODU
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 1:2561 SPRINGHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3994
Mailing Address - Country:US
Mailing Address - Phone:757-430-3831
Mailing Address - Fax:
Practice Address - Street 1:2293 UPTON DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-1186
Practice Address - Country:US
Practice Address - Phone:757-430-4175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist