Healthcare Provider Details

I. General information

NPI: 1326320193
Provider Name (Legal Business Name): OSATOHANMWEN KIMBERLY OKUNBOR PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6135 HIDDEN BROOK DR
TRUSSVILLE AL
35173-2374
US

IV. Provider business mailing address

6135 HIDDEN BROOK DRIVE
TRUSSVILLE AL
35173
US

V. Phone/Fax

Practice location:
  • Phone: 205-661-1041
  • Fax:
Mailing address:
  • Phone: 205-833-6882
  • Fax: 205-833-7046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16345
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: