Healthcare Provider Details

I. General information

NPI: 1669690665
Provider Name (Legal Business Name): OLADAPO AJIBOLA KOLAWOLE MS, PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW # M7106 MAIN BUILDING
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

P.O. BOX 7246
SILVER SPRING MD
20907
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-7755
  • Fax: 202-444-4443
Mailing address:
  • Phone: 202-444-7755
  • Fax: 202-444-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number12607
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number12607
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: