Healthcare Provider Details

I. General information

NPI: 1114257565
Provider Name (Legal Business Name): ISAAC OKECHUKWU OKOYE R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PINON ROUTE 4 AT PINON PHARMACY
PINON AZ
85610
US

IV. Provider business mailing address

19450 LORAIN RD APT # 210W
FAIRVIEW PARK OH
44126-1975
US

V. Phone/Fax

Practice location:
  • Phone: 928-725-9500
  • Fax: 928-725-9542
Mailing address:
  • Phone: 440-356-1073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03316871
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: