Healthcare Provider Details

I. General information

NPI: 1407671654
Provider Name (Legal Business Name): NANDI PRISCILLA OKONKWO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13199 SW 112TH ST
MIAMI FL
33186-4600
US

IV. Provider business mailing address

13199 SW 112TH ST
MIAMI FL
33186-4600
US

V. Phone/Fax

Practice location:
  • Phone: 305-382-4161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS67834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: