Healthcare Provider Details

I. General information

NPI: 1538611645
Provider Name (Legal Business Name): TERESA OKALA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11306 BIRKDALE CT
BOWIE MD
20721-5202
US

IV. Provider business mailing address

11306 BIRKDALE CT
BOWIE MD
20721-5202
US

V. Phone/Fax

Practice location:
  • Phone: 301-613-3870
  • Fax:
Mailing address:
  • Phone: 301-613-3870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number11319
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: