MEDICARE: BUKOLA AJIBADE

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	22562	MD

General Provider Information

NPI Number	:	1972976413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BUKOLA AJIBADE

Provider Business Mailing Address
First Line	:	5309 BELAIR RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21206-5109
Country	:	US
Telephone Number	:	410-601-3136
Fax Number	:	443-552-7481

Provider Business Practice Location Address
First Line	:	4532 ERDMAN AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21213-2606
Country	:	US
Telephone Number	:	410-488-5091
Fax Number	:

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

Provider Enumeration Date	:	11/05/2015
Last Update Date	:	06/19/2023

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Directions to “ BUKOLA AJIBADE ” Practice Location

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