Healthcare Provider Details

I. General information

NPI: 1619965217
Provider Name (Legal Business Name): MARTIN H OKNER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SHERIDAN RD DEL LAGO PHARMACY
WILMETTE IL
60091-1822
US

IV. Provider business mailing address

992 CUMBERLAND LN
BUFFALO GROVE IL
60089-7038
US

V. Phone/Fax

Practice location:
  • Phone: 847-256-3950
  • Fax: 847-256-3957
Mailing address:
  • Phone: 847-256-3950
  • Fax: 847-256-3957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: