1518253277 NPI number — DR. KEHINDE MODUPEOLU BANKOLE PHARMD

Table of content: DR. KEHINDE MODUPEOLU BANKOLE PHARMD (NPI 1518253277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518253277 NPI number — DR. KEHINDE MODUPEOLU BANKOLE PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANKOLE
Provider First Name:
KEHINDE
Provider Middle Name:
MODUPEOLU
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518253277
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3709 GREEN ASH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELTSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20705-3850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3709 GREEN ASH CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELTSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20705-3850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-593-7949
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  18659 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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