MEDICARE: LOLA LAWAL ISHOLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)
2	183500000X	Pharmacist	115449	MN
3	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	115449	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043543952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOLA LAWAL ISHOLA

Provider Business Mailing Address
First Line	:	2117 VERMILLION CURV
Second Line	:
City	:	WOODBURY
State	:	MN
Zip	:	55129-6225
Country	:	US
Telephone Number	:	651-503-7419
Fax Number	:

Provider Business Practice Location Address
First Line	:	2564 7TH AVE E
Second Line	:
City	:	NORTH SAINT PAUL
State	:	MN
Zip	:	55109-3010
Country	:	US
Telephone Number	:	651-770-6606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	06/13/2012

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Directions to “ LOLA LAWAL ISHOLA ” Practice Location

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