Healthcare Provider Details

I. General information

NPI: 1487316352
Provider Name (Legal Business Name): PATRICK OKOJIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 TILLMAN RD UNIT 704
STATESBORO GA
30458-0308
US

IV. Provider business mailing address

121 TILLMAN RD UNIT 704
STATESBORO GA
30458-0308
US

V. Phone/Fax

Practice location:
  • Phone: 678-471-6500
  • Fax:
Mailing address:
  • Phone: 678-471-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH019047
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: