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General NPI Number Information
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NPI Number | 1972976413
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Entity Type | Individual
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Provider Name | BUKOLA AJIBADE
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Gender | Female
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 4532 ERDMAN AVE
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City | BALTIMORE
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State | MD
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Zip | 21213-2606
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Country | US
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Telephone | 410-488-5091
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Fax |
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Provider Business Mailing Address
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Address Line | 5309 BELAIR RD
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City | BALTIMORE
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State | MD
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Zip | 21206-5109
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Country | US
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Telephone | 410-601-3136
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Fax | 443-552-7481
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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 | 22562
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License Number State | MD
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