Provider Demographics
NPI:1487880092
Name:ADEGBENRO, ADEBIMPE A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ADEBIMPE
Middle Name:A
Last Name:ADEGBENRO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6827 WESTRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-6457
Mailing Address - Country:US
Mailing Address - Phone:443-520-0563
Mailing Address - Fax:
Practice Address - Street 1:6827 WESTRIDGE RD
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-6457
Practice Address - Country:US
Practice Address - Phone:443-520-0563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist