Provider Demographics
NPI:1982801064
Name:AJEIGBE, OLAIDE O
Entity Type:Individual
Prefix:
First Name:OLAIDE
Middle Name:O
Last Name:AJEIGBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLAIDE
Other - Middle Name:
Other - Last Name:SHONUBI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8023 MOSS BANK DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2932
Mailing Address - Country:US
Mailing Address - Phone:301-725-3437
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:STE 240
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:610-834-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist