Provider Demographics
NPI:1144952367
Name:ADEYEMO, ABIOLA ABIODUN (RPH)
Entity type:Individual
Prefix:
First Name:ABIOLA
Middle Name:ABIODUN
Last Name:ADEYEMO
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 1:3202 W BAKER ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-2849
Mailing Address - Country:US
Mailing Address - Phone:813-679-0133
Mailing Address - Fax:
Practice Address - Street 1:24170 US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33859-7801
Practice Address - Country:US
Practice Address - Phone:863-676-7569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist