Healthcare Provider Details

I. General information

NPI: 1396584009
Provider Name (Legal Business Name): WALTER OKOYE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8005 GRAMERCY BLVD STE 180
DERWOOD MD
20855-2884
US

IV. Provider business mailing address

8326 GLENMAR RD
ELLICOTT CITY MD
21043-6993
US

V. Phone/Fax

Practice location:
  • Phone: 301-354-8010
  • Fax:
Mailing address:
  • Phone: 443-823-0705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29731
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: