Healthcare Provider Details

I. General information

NPI: 1366059263
Provider Name (Legal Business Name): JOAN IJEOMA OKWARA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

496 HIGHWAY 96 S
SILSBEE TX
77656-4810
US

IV. Provider business mailing address

520 DOWLEN RD APT 85
BEAUMONT TX
77706-6034
US

V. Phone/Fax

Practice location:
  • Phone: 409-386-6959
  • Fax:
Mailing address:
  • Phone: 978-996-7427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57863
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: