=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902126675
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW OBAH OKOLO PHARMACIST
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2010
-----------------------------------------------------
Last Update Date | 02/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 FLORIN RD
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95831-1405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-399-0650
-----------------------------------------------------
Fax | 916-399-0656
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9648 NATURE TRAIL WAY
-----------------------------------------------------
City | ELK GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95757-8131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-322-9279
-----------------------------------------------------
Fax | 916-627-1550
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH 59518
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------