MEDICARE: SAMUEL ADEYIGA TUDOR PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PHA.0025081	CO

General Provider Information

NPI Number	:	1275345324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL ADEYIGA TUDOR PHARMD

Provider Business Mailing Address
First Line	:	2133 SANDBUR DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5722
Country	:	US
Telephone Number	:	720-980-0452
Fax Number	:

Provider Business Practice Location Address
First Line	:	2133 SANDBUR DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5722
Country	:	US
Telephone Number	:	720-980-0452
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2025
Last Update Date	:	01/24/2025

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