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General NPI Number Information
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NPI Number | 1114352184
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Entity Type | Individual
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Provider Name | KENNETH C OKWUNWANNE
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Gender | Male
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 1900 BATAAN MEMORIAL E
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City | LAS CRUCES
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State | NM
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Zip | 88011-6011
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Country | US
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Telephone | 575-522-8603
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Fax |
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Provider Business Mailing Address
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Address Line | 596 PAT CRUZ
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City | EL PASO
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State | TX
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Zip | 79932-4107
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Country | US
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Telephone | 915-261-9713
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP00005662
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 31267
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License Number State | TX
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