Healthcare Provider Details

I. General information

NPI: 1902126675
Provider Name (Legal Business Name): ANDREW OBAH OKOLO PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 FLORIN RD
SACRAMENTO CA
95831-1405
US

IV. Provider business mailing address

9648 NATURE TRAIL WAY
ELK GROVE CA
95757-8131
US

V. Phone/Fax

Practice location:
  • Phone: 916-399-0650
  • Fax: 916-399-0656
Mailing address:
  • Phone: 619-322-9279
  • Fax: 916-627-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 59518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: