Healthcare Provider Details

I. General information

NPI: 1013168533
Provider Name (Legal Business Name): ALEXANDER C OKWONNA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 02/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5402 BALMORHEA DR
PEARLAND TX
77584-1449
US

IV. Provider business mailing address

12206 BECKFIELD CT
HOUSTON TX
77099-3811
US

V. Phone/Fax

Practice location:
  • Phone: 832-496-1977
  • Fax:
Mailing address:
  • Phone: 832-657-1906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42116
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number42116
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number42116
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number42116
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: