Healthcare Provider Details

I. General information

NPI: 1639456577
Provider Name (Legal Business Name): OLADIPO OLUSOJI ADEBISI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 N DECATUR RD
DECATUR GA
30033-5911
US

IV. Provider business mailing address

2875 N DECATUR RD
DECATUR GA
30033-5911
US

V. Phone/Fax

Practice location:
  • Phone: 404-294-8211
  • Fax: 404-296-9787
Mailing address:
  • Phone: 404-294-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH027760
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: