Healthcare Provider Details

I. General information

NPI: 1578993622
Provider Name (Legal Business Name): TRACY OKOLO BSN,PHARMD,BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 ST JOSEPH PKWY SUITE 1400
HOUSTON TX
77002-8233
US

IV. Provider business mailing address

1315 ST JOSEPH PKWY SUITE 1400
HOUSTON TX
77002-8233
US

V. Phone/Fax

Practice location:
  • Phone: 281-727-3943
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number49362
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number17878
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number16586-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: