Healthcare Provider Details

I. General information

NPI: 1437407228
Provider Name (Legal Business Name): MAENNE A OKUNOLA PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S SLAPPEY BLVD
ALBANY GA
31701-2606
US

IV. Provider business mailing address

205 PHILEMA RD APT 303
ALBANY GA
31701-1361
US

V. Phone/Fax

Practice location:
  • Phone: 229-435-7115
  • Fax:
Mailing address:
  • Phone: 229-496-1786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH026831
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: