Provider Demographics
NPI:1396156956
Name:OKWUOSA, GENEVIV (RPH)
Entity type:Individual
Prefix:
First Name:GENEVIV
Middle Name:
Last Name:OKWUOSA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4551 MACK RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-4532
Mailing Address - Country:US
Mailing Address - Phone:916-217-9201
Mailing Address - Fax:
Practice Address - Street 1:4551 MACK RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4532
Practice Address - Country:US
Practice Address - Phone:916-217-9201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69337183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist