Healthcare Provider Details

I. General information

NPI: 1902185531
Provider Name (Legal Business Name): ORHWERAKPOJEMRE OKOH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEMRE OKOH PHARMD

II. Dates (important events)

Enumeration Date: 08/13/2011
Last Update Date: 08/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SW 2ND AVE
MILTON FREEWATER OR
97862-1373
US

IV. Provider business mailing address

105 SW 2ND AVE
MILTON FREEWATER OR
97862-1373
US

V. Phone/Fax

Practice location:
  • Phone: 541-938-8778
  • Fax: 541-938-6072
Mailing address:
  • Phone: 541-938-8778
  • Fax: 541-938-6072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0012684
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP6519
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: