Provider Demographics
NPI:1538561410
Name:ADEMOYO, YETUNDE ADEBUSAYO (PHARMD)
Entity type:Individual
Prefix:
First Name:YETUNDE
Middle Name:ADEBUSAYO
Last Name:ADEMOYO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:YETUNDE
Other - Middle Name:ADEBUSAYO
Other - Last Name:ADEMOYO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:249 ARROWHEAD ST
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1437
Mailing Address - Country:US
Mailing Address - Phone:708-979-7546
Mailing Address - Fax:
Practice Address - Street 1:7236 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-2408
Practice Address - Country:US
Practice Address - Phone:219-937-0337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051298031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist