Provider Demographics
NPI:1740806124
Name:KOLADE, VICTOR A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:A
Last Name:KOLADE
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 1:12377 PASEO ALEGRE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5665
Mailing Address - Country:US
Mailing Address - Phone:915-929-4926
Mailing Address - Fax:
Practice Address - Street 1:2950 GEORGE DIETER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-2913
Practice Address - Country:US
Practice Address - Phone:915-856-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009279183500000X
TX65995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist