Healthcare Provider Details

I. General information

NPI: 1093562142
Provider Name (Legal Business Name): INNOCENT OKOH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11890 HEALING WAY
SILVER SPRING MD
20904-7917
US

IV. Provider business mailing address

8301 GOVERNOR RUN
ELLICOTT CITY MD
21043-3448
US

V. Phone/Fax

Practice location:
  • Phone: 240-637-5556
  • Fax:
Mailing address:
  • Phone: 202-415-5925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17334
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: