Provider Demographics
NPI:1699785154
Name:ADEDAPO, OLUTOYIN AMOS (RPH)
Entity type:Individual
Prefix:MR
First Name:OLUTOYIN
Middle Name:AMOS
Last Name:ADEDAPO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2808
Mailing Address - Country:US
Mailing Address - Phone:410-228-8855
Mailing Address - Fax:
Practice Address - Street 1:300 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2808
Practice Address - Country:US
Practice Address - Phone:410-228-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1317440001Medicare ID - Type Unspecified