Provider Demographics
NPI:1386233948
Name:OJEMUYIWA, ADEFOLAKE TOLULOPE (RPH)
Entity type:Individual
Prefix:
First Name:ADEFOLAKE
Middle Name:TOLULOPE
Last Name:OJEMUYIWA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43701
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30336-0701
Mailing Address - Country:US
Mailing Address - Phone:404-600-5666
Mailing Address - Fax:
Practice Address - Street 1:541 FOREST PKWY STE 4
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-2147
Practice Address - Country:US
Practice Address - Phone:404-600-5666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003154268AMedicaid