Provider Demographics
NPI:1134785686
Name:OKOYE, OLIVER C (PHARMD)
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:C
Last Name:OKOYE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 E ISAACS AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2214
Mailing Address - Country:US
Mailing Address - Phone:509-529-1917
Mailing Address - Fax:
Practice Address - Street 1:2028 E ISAACS AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2214
Practice Address - Country:US
Practice Address - Phone:509-529-1917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH608896471835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH60889647OtherWASHINGTON STATE BOARD OF PHARMACY