Provider Demographics
NPI:1952692576
Name:AKINBO, KEHINDE ADEYEMI
Entity Type:Individual
Prefix:
First Name:KEHINDE
Middle Name:ADEYEMI
Last Name:AKINBO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11110 FLATLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-8234
Mailing Address - Country:US
Mailing Address - Phone:718-649-2522
Mailing Address - Fax:718-272-5452
Practice Address - Street 1:11110 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-8234
Practice Address - Country:US
Practice Address - Phone:718-649-2522
Practice Address - Fax:718-272-5452
Is Sole Proprietor?:No
Enumeration Date:2011-04-30
Last Update Date:2011-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055387-1183500000X, 1835P0018X
NY055387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist