Provider Demographics
NPI:1063713188
Name:ASOOTO, AKINTOMIDE JERRY
Entity type:Individual
Prefix:MR
First Name:AKINTOMIDE
Middle Name:JERRY
Last Name:ASOOTO
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 1:2401 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5110
Mailing Address - Country:US
Mailing Address - Phone:410-261-6112
Mailing Address - Fax:
Practice Address - Street 1:2401 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5110
Practice Address - Country:US
Practice Address - Phone:410-261-6112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist