Healthcare Provider Details

I. General information

NPI: 1134729189
Provider Name (Legal Business Name): ANNA-MAUREEN ALADEJEBI PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAUREEN ALADEJEBI

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 COMMERCE DR
LAFAYETTE IN
47905-3800
US

IV. Provider business mailing address

200 PAWNEE DR
WEST LAFAYETTE IN
47906-2115
US

V. Phone/Fax

Practice location:
  • Phone: 765-446-1278
  • Fax:
Mailing address:
  • Phone: 317-201-1438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number26022186A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: