Provider Demographics
NPI:1023387206
Name:OBIWOLE, ADETOLA A
Entity type:Individual
Prefix:DR
First Name:ADETOLA
Middle Name:A
Last Name:OBIWOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5166 DILLON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-4140
Mailing Address - Country:US
Mailing Address - Phone:303-257-2150
Mailing Address - Fax:
Practice Address - Street 1:4602 N ELIZABETH STREET STE. 190
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2093
Practice Address - Country:US
Practice Address - Phone:800-517-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-18
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist