Healthcare Provider Details

I. General information

NPI: 1154286243
Provider Name (Legal Business Name): ADETUNJI ODUNLAMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5016 TEN OAKS RD
CLARKSVILLE MD
21029-1029
US

IV. Provider business mailing address

5016 TEN OAKS RD
CLARKSVILLE MD
21029-1029
US

V. Phone/Fax

Practice location:
  • Phone: 410-493-5121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: