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General NPI Number Information
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NPI Number | 1497036412
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Entity Type | Individual
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Provider Name | ADEDOTUN AJAGUNNA PHARMD, RPH
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Gender | Male
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Dates
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Enumeration Date | 09/03/2011
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Last Update Date | 09/03/2011
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Provider Practice Location Address
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Address Line | 6101 W 70TH ST
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City | SHREVEPORT
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State | LA
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Zip | 71129-2507
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Country | US
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Telephone | 318-688-1448
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Fax |
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Provider Business Mailing Address
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Address Line | 3501 CHAMPION LAKE BLVD APT. 1609
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City | SHREVEPORT
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State | LA
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Zip | 71105-3772
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 019279
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 49662
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License Number State | TX
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