Provider Demographics
NPI:1902126675
Name:OKOLO, ANDREW OBAH (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:OBAH
Last Name:OKOLO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9648 NATURE TRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8131
Mailing Address - Country:US
Mailing Address - Phone:619-322-9279
Mailing Address - Fax:916-627-1550
Practice Address - Street 1:250 FLORIN RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-1405
Practice Address - Country:US
Practice Address - Phone:916-399-0650
Practice Address - Fax:916-399-0656
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 59518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist