Healthcare Provider Details

I. General information

NPI: 1134618960
Provider Name (Legal Business Name): ANNE THERESE OKOLO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 W FOOTHILL BLVD
UPLAND CA
91786-3653
US

IV. Provider business mailing address

101 W MISSION BLVD STE 110-205
POMONA CA
91766-1711
US

V. Phone/Fax

Practice location:
  • Phone: 909-920-0942
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: