Healthcare Provider Details

I. General information

NPI: 1508033259
Provider Name (Legal Business Name): JOHN OKECHUKWU OKONKWO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E FLORENCE AVE STE BANDC
LOS ANGELES CA
90001-1963
US

IV. Provider business mailing address

1350 E FLORENCE AVE STE BANDC
LOS ANGELES CA
90001-1963
US

V. Phone/Fax

Practice location:
  • Phone: 323-457-9278
  • Fax: 323-457-9265
Mailing address:
  • Phone: 323-457-9278
  • Fax: 323-457-9265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH57029
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: