Healthcare Provider Details

I. General information

NPI: 1457951477
Provider Name (Legal Business Name): DAVID EDARAMFON OKON PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N JACKSON RD
HIDALGO TX
78557-3882
US

IV. Provider business mailing address

2715 ROSEPOINT CT
FRESNO TX
77545-1420
US

V. Phone/Fax

Practice location:
  • Phone: 956-904-4829
  • Fax: 956-904-4830
Mailing address:
  • Phone: 830-320-1415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56982
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: