Healthcare Provider Details

I. General information

NPI: 1104852607
Provider Name (Legal Business Name): PADEK HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5403A ANNAPOLIS RD
BLADENSBURG MD
20710-2201
US

IV. Provider business mailing address

5403A ANNAPOLIS RD
BLADENSBURG MD
20710-2201
US

V. Phone/Fax

Practice location:
  • Phone: 301-277-7107
  • Fax: 301-277-7127
Mailing address:
  • Phone: 301-277-7107
  • Fax: 301-277-7127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP04314
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberP04314
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberP04314
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberP04314
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberP04314
License Number StateMD
# 6
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP04314
License Number StateMD

VIII. Authorized Official

Name: DR. PRINCE AYODELE ADEKOYA JR.
Title or Position: PHARMACIST OWNER
Credential: PHARM.D
Phone: 301-277-7107