Healthcare Provider Details

I. General information

NPI: 1417692930
Provider Name (Legal Business Name): VCITOR OKWUTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 CYPRESS MANOR DR APT 109
TAMPA FL
33647-3826
US

IV. Provider business mailing address

8803 CYPRESS MANOR DR APT 109
TAMPA FL
33647-3826
US

V. Phone/Fax

Practice location:
  • Phone: 713-231-7072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS37354
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: