Healthcare Provider Details

I. General information

NPI: 1649403577
Provider Name (Legal Business Name): MRS. CHINYERE GENEVIEVE OKAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 N GENERALS BLVD
LINCOLNTON NC
28092-3557
US

IV. Provider business mailing address

11805 SOUTHCREST LN
PINEVILLE NC
28134-9129
US

V. Phone/Fax

Practice location:
  • Phone: 704-732-3095
  • Fax: 704-732-3097
Mailing address:
  • Phone: 704-488-3124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15356
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: