Healthcare Provider Details

I. General information

NPI: 1699584102
Provider Name (Legal Business Name): GREGORY NKWE NKEPANG PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12240 N MAY AVE
OKLAHOMA CITY OK
73120-6806
US

IV. Provider business mailing address

18509 ABIERTO DR
EDMOND OK
73012-9613
US

V. Phone/Fax

Practice location:
  • Phone: 405-751-1938
  • Fax: 405-751-0445
Mailing address:
  • Phone: 405-658-8087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number20185
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: