Healthcare Provider Details

I. General information

NPI: 1356905418
Provider Name (Legal Business Name): CHINEZE OKONKWO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N 10TH AVE
HANFORD CA
93230-2391
US

IV. Provider business mailing address

2255 S STANFORD AVE
FRESNO CA
93727-6573
US

V. Phone/Fax

Practice location:
  • Phone: 559-587-9626
  • Fax:
Mailing address:
  • Phone: 559-349-4975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number80007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: