Provider Demographics
NPI:1871315531
Name:ADESIOYE, ADESUMBO
Entity type:Individual
Prefix:
First Name:ADESUMBO
Middle Name:
Last Name:ADESIOYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10328 BOCA ENTRADA BLVD APT 120
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-5801
Mailing Address - Country:US
Mailing Address - Phone:424-558-4135
Mailing Address - Fax:
Practice Address - Street 1:10328 BOCA ENTRADA BLVD APT 120
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-5801
Practice Address - Country:US
Practice Address - Phone:424-558-4135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH606331835P0018X
FLPS44628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist