Healthcare Provider Details

I. General information

NPI: 1851794630
Provider Name (Legal Business Name): TAIWO OKUNADE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 JOE BATTLE BLVD SUITE 10
EL PASO TX
79938-2628
US

IV. Provider business mailing address

3660 JOE BATTLE BLVD SUITE 10
EL PASO TX
79938-2628
US

V. Phone/Fax

Practice location:
  • Phone: 915-857-5510
  • Fax: 915-857-5505
Mailing address:
  • Phone: 915-857-5510
  • Fax: 915-857-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number41384
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: