Provider Demographics
NPI:1487101770
Name:AKINWANDE, AYODEJI
Entity type:Individual
Prefix:
First Name:AYODEJI
Middle Name:
Last Name:AKINWANDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9986 SHERWOOD FARM RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5853
Mailing Address - Country:US
Mailing Address - Phone:718-200-3195
Mailing Address - Fax:
Practice Address - Street 1:9986 SHERWOOD FARM RD
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5853
Practice Address - Country:US
Practice Address - Phone:718-200-3195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist