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General NPI Number Information
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NPI Number | 1568746428
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Entity Type | Individual
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Provider Name | MR. OMOTAYO OLUFEMI BADEJOKO
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Gender | Male
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 1100 WEST MAIN STREET
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City | NORRISTOWN
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State | PA
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Zip | 19401
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Country | US
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Telephone | 610-292-9960
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Fax |
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Provider Business Mailing Address
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Address Line | 7817 CHELTENHAM AVE
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City | LAVEROCK
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State | PA
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Zip | 19038-7621
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Country | US
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Telephone | 215-233-0242
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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 | RP444344
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License Number State | PA
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