Provider Demographics
NPI:1992541866
Name:LADELE, BOLUTIFE (RPH)
Entity type:Individual
Prefix:
First Name:BOLUTIFE
Middle Name:
Last Name:LADELE
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 1:19718 BRASSIE PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-1900
Mailing Address - Country:US
Mailing Address - Phone:240-618-6062
Mailing Address - Fax:
Practice Address - Street 1:10125 WARD RD
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754
Practice Address - Country:US
Practice Address - Phone:240-618-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist