Provider Demographics
NPI:1427651660
Name:ODUNOWO, ADEJUMOKE T
Entity type:Individual
Prefix:
First Name:ADEJUMOKE
Middle Name:T
Last Name:ODUNOWO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6132 WHITE MARBLE CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1658
Mailing Address - Country:US
Mailing Address - Phone:301-922-1630
Mailing Address - Fax:
Practice Address - Street 1:6223 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-2910
Practice Address - Country:US
Practice Address - Phone:410-788-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist