Healthcare Provider Details

I. General information

NPI: 1770915621
Provider Name (Legal Business Name): CHIKE NNAMDI OKOLO PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR RD
MARTINEZ CA
94553-4668
US

IV. Provider business mailing address

3300 CAPITAL CENTER DR APT 32
RANCHO CORDOVA CA
95670-7973
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-2000
  • Fax:
Mailing address:
  • Phone: 530-635-2677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number69023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: