Healthcare Provider Details

I. General information

NPI: 1043629850
Provider Name (Legal Business Name): ADENIKE KUPOLATI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 ALTAMONT PLACE
WHITE PLAINS MD
20695
US

IV. Provider business mailing address

4220 ALTAMONT PLACE
WHITE PLAINS MD
20695
US

V. Phone/Fax

Practice location:
  • Phone: 301-645-2774
  • Fax: 301-638-0278
Mailing address:
  • Phone: 301-645-2774
  • Fax: 301-638-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15417
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: