Healthcare Provider Details

I. General information

NPI: 1912546029
Provider Name (Legal Business Name): MOSES OKINE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 CALIFORNIA AVE STE 400B
BAKERSFIELD CA
93309-7081
US

IV. Provider business mailing address

24412 VALLE DEL ORO UNIT 205
SANTA CLARITA CA
91321-4285
US

V. Phone/Fax

Practice location:
  • Phone: 661-459-1900
  • Fax:
Mailing address:
  • Phone: 267-632-1692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number80834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: