Healthcare Provider Details

I. General information

NPI: 1427937143
Provider Name (Legal Business Name): RAHEEMOT OLATAYO ISOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 MALCOLM X BLVD
NEW YORK NY
10037-1806
US

IV. Provider business mailing address

120 ODELL CLARK PL APT 6G
NEW YORK NY
10030-2375
US

V. Phone/Fax

Practice location:
  • Phone: 212-283-2136
  • Fax: 212-283-2463
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number07277401
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: