Healthcare Provider Details

I. General information

NPI: 1386955276
Provider Name (Legal Business Name): DR. IFEDINMA NNENNA OKONKWO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 HARFORD AVE
BALTIMORE MD
21202-5705
US

IV. Provider business mailing address

1521 HARFORD AVE
BALTIMORE MD
21202-5705
US

V. Phone/Fax

Practice location:
  • Phone: 410-962-5541
  • Fax:
Mailing address:
  • Phone: 410-962-5541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14066
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH3151
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: