Healthcare Provider Details

I. General information

NPI: 1720682305
Provider Name (Legal Business Name): CHINWE OKONKWO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 SIERRA CENTER PKWY
RENO NV
89511-2214
US

IV. Provider business mailing address

6845 SIERRA CENTER PKWY
RENO NV
89511-2214
US

V. Phone/Fax

Practice location:
  • Phone: 775-853-8916
  • Fax:
Mailing address:
  • Phone: 775-853-8916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number20351
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: