Healthcare Provider Details

I. General information

NPI: 1447913785
Provider Name (Legal Business Name): BASILIA OKWUCHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 PROFESSIONAL PL
LANDOVER MD
20785-2237
US

IV. Provider business mailing address

8002 RIVER FIELD CT
BOWIE MD
20715-3305
US

V. Phone/Fax

Practice location:
  • Phone: 703-216-0896
  • Fax:
Mailing address:
  • Phone: 240-486-2986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202219691
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: