Healthcare Provider Details

I. General information

NPI: 1205311024
Provider Name (Legal Business Name): CHIOMA OKOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 BLUE HILL AVE
DORCHESTER MA
02121-3213
US

IV. Provider business mailing address

32 HILL ST
FOXBORO MA
02035-1227
US

V. Phone/Fax

Practice location:
  • Phone: 617-825-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH237830
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: