Healthcare Provider Details

I. General information

NPI: 1053911404
Provider Name (Legal Business Name): AUSTIN OKOYE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 N COCKRELL HILL RD
DALLAS TX
75211-1315
US

IV. Provider business mailing address

3015 NADAR
GRAND PRAIRIE TX
75054-6791
US

V. Phone/Fax

Practice location:
  • Phone: 214-337-8092
  • Fax: 214-337-8359
Mailing address:
  • Phone: 682-222-7494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42726
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: