Provider Demographics
NPI:1124704044
Name:ANNOVEX PHARMA, INC
Entity type:Organization
Organization Name:ANNOVEX PHARMA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEDAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINBI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:571-366-5316
Mailing Address - Street 1:7403 LOCKPORT PL SUITE C
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1153
Mailing Address - Country:US
Mailing Address - Phone:571-642-5262
Mailing Address - Fax:
Practice Address - Street 1:7403 LOCKPORT PL SUITE C
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1153
Practice Address - Country:US
Practice Address - Phone:571-642-5262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy