Healthcare Provider Details

I. General information

NPI: 1427335660
Provider Name (Legal Business Name): CHRISTOPHER OKOLI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 11/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 PARK ST
JACKSONVILLE FL
32205-7607
US

IV. Provider business mailing address

2703 PARK ST
JACKSONVILLE FL
32205-7607
US

V. Phone/Fax

Practice location:
  • Phone: 904-384-8929
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS43765
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: