Provider Demographics
NPI:1386935666
Name:OLAYEMI, ADETUNJI IDOWU (PHARMD)
Entity type:Individual
Prefix:
First Name:ADETUNJI
Middle Name:IDOWU
Last Name:OLAYEMI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6949 WOODHAVEN PLACE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228-2804
Mailing Address - Country:US
Mailing Address - Phone:502-671-8436
Mailing Address - Fax:
Practice Address - Street 1:4149 TAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-2366
Practice Address - Country:US
Practice Address - Phone:502-375-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist