Healthcare Provider Details

I. General information

NPI: 1659747756
Provider Name (Legal Business Name): BERNARD OKWELOGU PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 E ASHLAN AVE
FRESNO CA
93726-2019
US

IV. Provider business mailing address

1804 E ASHLAN AVE
FRESNO CA
93726-2019
US

V. Phone/Fax

Practice location:
  • Phone: 559-470-6969
  • Fax: 559-470-6970
Mailing address:
  • Phone: 559-470-6969
  • Fax: 559-470-6970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number39630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: