Provider Demographics
NPI:1447852496
Name:KING, ADEDIPUPO OLUWASEUN (RPH)
Entity type:Individual
Prefix:
First Name:ADEDIPUPO
Middle Name:OLUWASEUN
Last Name:KING
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 S KALAMAZOO ST
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-9230
Mailing Address - Country:US
Mailing Address - Phone:269-657-4984
Mailing Address - Fax:
Practice Address - Street 1:848 S KALAMAZOO ST
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-9230
Practice Address - Country:US
Practice Address - Phone:269-657-4984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302046307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist