Healthcare Provider Details

I. General information

NPI: 1982743019
Provider Name (Legal Business Name): OLANREWAJU ABRAHAM LANRE-KOLAWOLE R. PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2858 N PINAL AVE
CASA GRANDE AZ
85122-7917
US

IV. Provider business mailing address

3790 E SEBASTIAN LN
GILBERT AZ
85297-5247
US

V. Phone/Fax

Practice location:
  • Phone: 520-426-4701
  • Fax:
Mailing address:
  • Phone: 520-431-7578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14624
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: