Provider Demographics
NPI:1154921633
Name:AJIKOBI, ADETUNJI O
Entity type:Individual
Prefix:
First Name:ADETUNJI
Middle Name:O
Last Name:AJIKOBI
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 1:6721 CHESAPEAKE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-6572
Mailing Address - Country:US
Mailing Address - Phone:410-863-1285
Mailing Address - Fax:410-863-1287
Practice Address - Street 1:6721 CHESAPEAKE CENTER DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-6572
Practice Address - Country:US
Practice Address - Phone:410-863-1285
Practice Address - Fax:410-863-1287
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist