MEDICARE: KENNETH C OKWUNWANNE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP00005662	NM
2	183500000X	Pharmacist	31267	TX

General Provider Information

NPI Number	:	1114352184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH C OKWUNWANNE

Provider Business Mailing Address
First Line	:	596 PAT CRUZ
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79932-4107
Country	:	US
Telephone Number	:	915-261-9713
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 BATAAN MEMORIAL E
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-6011
Country	:	US
Telephone Number	:	575-522-8603
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2013
Last Update Date	:	09/10/2013

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Directions to “ KENNETH C OKWUNWANNE ” Practice Location

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