Provider Demographics
NPI:1538757091
Name:ADEOSO, SAMUEL (PHARMD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:ADEOSO
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 1:1155 RIPLEY ST APT 1414
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-7465
Mailing Address - Country:US
Mailing Address - Phone:508-579-3912
Mailing Address - Fax:
Practice Address - Street 1:7809 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3523
Practice Address - Country:US
Practice Address - Phone:301-986-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist