Provider Demographics
NPI:1891394185
Name:ISHOLA, KOLAWOLE (RPH)
Entity Type:Individual
Prefix:
First Name:KOLAWOLE
Middle Name:
Last Name:ISHOLA
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 1:2812 E BEARSS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2653
Mailing Address - Country:US
Mailing Address - Phone:813-988-4000
Mailing Address - Fax:813-849-1138
Practice Address - Street 1:2812 E BEARSS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2653
Practice Address - Country:US
Practice Address - Phone:813-988-4000
Practice Address - Fax:813-849-1138
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist