MEDICARE: MR. EDWARD O OKEBIORUN

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	RP446578	PA
2	183500000X	Pharmacist	28RI02694100	NJ

General Provider Information

NPI Number	:	1962950873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD O OKEBIORUN

Provider Business Mailing Address
First Line	:	3204 KENSINGTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-1918
Country	:	US
Telephone Number	:	215-427-1603
Fax Number	:

Provider Business Practice Location Address
First Line	:	3204 KENSINGTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-1918
Country	:	US
Telephone Number	:	215-427-1603
Fax Number	:

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

Provider Enumeration Date	:	09/20/2016
Last Update Date	:	05/11/2017

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Directions to “ MR. EDWARD O OKEBIORUN ” Practice Location

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