MEDICARE: MRS. KAFI B AGBOOLA

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	14797	MD

General Provider Information

NPI Number	:	1841269990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAFI B AGBOOLA

Provider Business Mailing Address
First Line	:	11507 BURNING TREE CT
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-2360
Country	:	US
Telephone Number	:	301-322-8082
Fax Number	:

Provider Business Practice Location Address
First Line	:	7936 JOHNSON AVE
Second Line	:
City	:	GLENARDEN
State	:	MD
Zip	:	20706-1772
Country	:	US
Telephone Number	:	301-322-8082
Fax Number	:

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	07/08/2007

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