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General NPI Number Information
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NPI Number | 1902196173
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Entity Type | Individual
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Provider Name | JEROME OKOLO RPH
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Gender | Male
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Dates
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Enumeration Date | 04/08/2011
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Last Update Date | 04/08/2011
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Provider Practice Location Address
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Address Line | 900 N MAIN ST
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City | MANTECA
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State | CA
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Zip | 95336-3743
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Country | US
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Telephone | 209-824-2948
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Fax |
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Provider Business Mailing Address
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Address Line | 1530 W CENTER ST APT 343
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City | MANTECA
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State | CA
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Zip | 95337-4277
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Country | US
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Telephone | 818-632-6620
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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 | 63786
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License Number State | CA
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