Healthcare Provider Details

I. General information

NPI: 1023772852
Provider Name (Legal Business Name): HENRY NNAMDI OKORO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E 33RD ST
BALTIMORE MD
21218-3505
US

IV. Provider business mailing address

1011 PECONIC PL
UPPER MARLBORO MD
20774-5704
US

V. Phone/Fax

Practice location:
  • Phone: 410-649-4181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28317
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: