NPIMap

Individual provider Active NPI

Adedotun Ajagunna, PHARMD, RPH

  • Pharmacist
  • Shreveport, LA
National Provider Identifier
1497036412
Registry record updated Sep 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
019279 Issued in LA
Practice address
6101 W 70TH St
Shreveport, LA 71129-2507
Phone
(318) 688-1448
NPI assigned
Sep 3, 2011
Last updated
Sep 3, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 019279 LA Primary
Pharmacist 183500000X 49662 TX

Addresses

Primary practice location

6101 W 70TH St
Shreveport, LA 71129-2507

Mailing address

3501 Champion Lake Blvd
Apt. 1609
Shreveport, LA 71105-3772

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
Credentials
Doctor of Pharmacy, Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
019279LAMDPharmacist
49662TXMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co Past Accepting new patients
Walgreen Co Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315008000000",
    "number": "1497036412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3501 CHAMPION LAKE BLVD",
            "address_2": "APT. 1609",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711053772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6101 W 70TH ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711292507",
            "telephone_number": "318-688-1448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AJAGUNNA",
        "first_name": "ADEDOTUN",
        "name_prefix": "Dr.",
        "credential": "PHARMD, RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-03",
        "last_updated": "2011-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "LA",
            "license": "019279",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "49662",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.