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NPI Code Detail

MEDICARE: NICHOLAS OKORONKWO

MEDICARE: NICHOLAS OKORONKWO
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
1183500000XPharmacist40445TX

General Provider Information

NPI Number : 1922385947
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS OKORONKWO
Provider Business Mailing Address
First Line : 4520 WESTERN CENTER BLVD
Second Line :
City : HALTOM CITY
State : TX
Zip : 76137-2635
Country : US
Telephone Number : 817-514-8063
Fax Number : 817-514-9570
Provider Business Practice Location Address
First Line : 4520 WESTERN CENTER BLVD
Second Line :
City : HALTOM CITY
State : TX
Zip : 76137-2635
Country : US
Telephone Number : 817-514-8063
Fax Number : 817-514-9570
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2011
Last Update Date : 11/04/2011

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Directions to “ NICHOLAS OKORONKWO ” Practice Location

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