Healthcare Provider Details

I. General information

NPI: 1881905636
Provider Name (Legal Business Name): MISS RACHEL BOIKOKOBETSO MOKGOKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2010
Last Update Date: 06/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E LITTLE CREEK RD
NORFOLK VA
23518-3824
US

IV. Provider business mailing address

1101 E LITTLE CREEK RD
NORFOLK VA
23518-3824
US

V. Phone/Fax

Practice location:
  • Phone: 757-588-8694
  • Fax: 757-480-5754
Mailing address:
  • Phone: 757-588-8694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202208310
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: