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General NPI Number Information
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NPI Number | 1689911992
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Entity Type | Organization
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Legal Business Name | AVALON PARK PHARMACY CORPORATION
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 457 AVALON PARK SOUTH BLVD SUITE 300
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City | ORLANDO
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State | FL
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Zip | 32828-6997
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Country | US
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Telephone | 407-482-8228
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Fax | 407-482-8229
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Provider Business Mailing Address
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Address Line | 457 AVALON PARK SOUTH BLVD SUITE 300
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City | ORLANDO
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State | FL
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Zip | 32828-6997
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Country | US
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Telephone | 407-482-8228
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Fax | 407-482-8229
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Authorized Official
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Title or Position | CEO
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Name | DR. VALENTINE CHIKE OKONKWO
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Credential | PHARM.D
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Telephone | 407-482-8228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | PH24071
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License Number State | FL
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