Healthcare Provider Details

I. General information

NPI: 1760149835
Provider Name (Legal Business Name): KEHINDE A ADESINA II PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 93111, CMR 10 CAMP BONSTEEL
APO AE
09240
US

IV. Provider business mailing address

1537 8TH ST NW
WASHINGTON DC
20001-3205
US

V. Phone/Fax

Practice location:
  • Phone: 314-781-4427
  • Fax:
Mailing address:
  • Phone: 707-474-7170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202212946
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: