Healthcare Provider Details

I. General information

NPI: 1710580691
Provider Name (Legal Business Name): STEPHEN I OKON PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2020
Last Update Date: 11/21/2020
Certification Date: 11/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 NW 27TH AVE
MIAMI FL
33125-3037
US

IV. Provider business mailing address

20440 NE 15TH AVE
MIAMI FL
33179-5106
US

V. Phone/Fax

Practice location:
  • Phone: 305-631-0874
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS52952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: