Healthcare Provider Details

I. General information

NPI: 1629661103
Provider Name (Legal Business Name): KENECHUKWU OKOLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 N ZARAGOZA RD
EL PASO TX
79936-7906
US

IV. Provider business mailing address

8300 W AIRPORT BLVD APT 1011
HOUSTON TX
77071-2944
US

V. Phone/Fax

Practice location:
  • Phone: 915-855-2745
  • Fax:
Mailing address:
  • Phone: 832-882-2415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65720
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: