Provider Demographics
NPI:1215442538
Name:ADEKA, DELALI (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:DELALI
Middle Name:
Last Name:ADEKA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20608 WHITEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3215
Mailing Address - Country:US
Mailing Address - Phone:571-214-1034
Mailing Address - Fax:
Practice Address - Street 1:10618 DEVCO DR
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-3466
Practice Address - Country:US
Practice Address - Phone:172-786-3403
Practice Address - Fax:727-863-4035
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47143183500000X
FL47143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015248500Medicaid