Healthcare Provider Details

I. General information

NPI: 1720435522
Provider Name (Legal Business Name): ROBERT OKWEMBA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2016
Last Update Date: 05/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9519 PHILADELPHIA RD
BALTIMORE MD
21237-4105
US

IV. Provider business mailing address

9519 PHILADELPHIA RD
BALTIMORE MD
21237-4105
US

V. Phone/Fax

Practice location:
  • Phone: 410-238-1071
  • Fax:
Mailing address:
  • Phone: 410-238-1071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0004777
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number23478
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: