Provider Demographics
NPI:1730411356
Name:BAMIGBADE, ADESHINA SHON
Entity type:Individual
Prefix:
First Name:ADESHINA
Middle Name:SHON
Last Name:BAMIGBADE
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 1:37 LAGUNA LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2482
Mailing Address - Country:US
Mailing Address - Phone:347-419-4345
Mailing Address - Fax:
Practice Address - Street 1:799 ALLERTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-547-7600
Practice Address - Fax:718-547-7606
Is Sole Proprietor?:No
Enumeration Date:2010-02-07
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist