Active NPI
Adetutu Komolafe
- Pharmacist
- Columbia, MD
National Provider Identifier
1063060150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26244
- Practice address
- 6111 Dobbin Rd
Columbia, MD 21045-2898 - Phone
- (410) 690-1044
- NPI assigned
- Aug 31, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26244 | MD | Primary |
Addresses
Primary practice location
6111 Dobbin Rd
Columbia, MD 21045-2898
Mailing address
5420 Lynx LN
Columbia, MD 21044-2484
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26244 | MD | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1567209600000",
"number": "1063060150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5420 LYNX LN",
"city": "COLUMBIA",
"state": "MD",
"postal_code": "210442484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6111 DOBBIN RD",
"city": "COLUMBIA",
"state": "MD",
"postal_code": "210452898",
"telephone_number": "410-690-1044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOMOLAFE",
"first_name": "ADETUTU",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-08-31",
"last_updated": "2019-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "26244",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.