Healthcare Provider Details

I. General information

NPI: 1174810097
Provider Name (Legal Business Name): CHARLES CECIL OKINE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15341 MONTANUS DR TARGET 2250
CULPEPER VA
22701
US

IV. Provider business mailing address

1220 KNIGHTSBRIDGE CT APT#205
CHARLOTTESVILLE VA
22911-4647
US

V. Phone/Fax

Practice location:
  • Phone: 540-828-6634
  • Fax:
Mailing address:
  • Phone: 804-986-1441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202207650
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: