Provider Demographics
NPI:1356658041
Name:KOLAWOLE, TITUS OLATUNDE (RPH)
Entity Type:Individual
Prefix:MR
First Name:TITUS
Middle Name:OLATUNDE
Last Name:KOLAWOLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 KINGSLEY LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-4070
Mailing Address - Country:US
Mailing Address - Phone:757-487-6841
Mailing Address - Fax:
Practice Address - Street 1:770 W. 21ST STREET
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1921
Practice Address - Country:US
Practice Address - Phone:757-627-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist