Healthcare Provider Details

I. General information

NPI: 1134808926
Provider Name (Legal Business Name): MITCHELL OKULA PHARMD. MPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10432 PATRIOT HWY
FREDERICKSBURG VA
22408-2628
US

IV. Provider business mailing address

10432 PATRIOT HWY
FREDERICKSBURG VA
22408-2628
US

V. Phone/Fax

Practice location:
  • Phone: 540-707-7074
  • Fax:
Mailing address:
  • Phone: 540-707-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberRP457327
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number28RI04305000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: