Healthcare Provider Details

I. General information

NPI: 1316541295
Provider Name (Legal Business Name): EL-SHEBA OKWEI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5469 MAPLEDALE PLAZA
DALE CITY VA
22193
US

IV. Provider business mailing address

5469 MAPLEDALE PLAZA
DALE CITY VA
22193
US

V. Phone/Fax

Practice location:
  • Phone: 703-590-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202219041
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: