Healthcare Provider Details

I. General information

NPI: 1215764592
Provider Name (Legal Business Name): NKIRU OKONKWO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13031 LEE JACKSON MEMORIAL HWY SERVICE RD
FAIRFAX VA
22033
US

IV. Provider business mailing address

23216 QUAIL SUMMIT DR
DIAMOND BAR CA
91765-3029
US

V. Phone/Fax

Practice location:
  • Phone: 703-378-7550
  • Fax:
Mailing address:
  • Phone: 909-762-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202222332
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: