Provider Demographics
NPI:1558923797
Name:KATAYE, KOLAWOLE ADESHINA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KOLAWOLE
Middle Name:ADESHINA
Last Name:KATAYE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9331 LANHAM SEVERN RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2730
Mailing Address - Country:US
Mailing Address - Phone:240-467-1424
Mailing Address - Fax:
Practice Address - Street 1:6498 LANDOVER RD
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1444
Practice Address - Country:US
Practice Address - Phone:301-773-1074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist