MEDICARE: PETER ADEOSUN 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	PS61391	FL

General Provider Information

NPI Number	:	1942803119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER ADEOSUN PHARMD

Provider Business Mailing Address
First Line	:	9801 S US HIGHWAY 1
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5628
Country	:	US
Telephone Number	:	772-337-2553
Fax Number	:

Provider Business Practice Location Address
First Line	:	9801 S US HIGHWAY 1
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5628
Country	:	US
Telephone Number	:	772-337-2553
Fax Number	:

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

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	11/19/2020

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Directions to “ PETER ADEOSUN PHARMD” Practice Location

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