Provider Demographics
NPI:1225315971
Name:OKWUEGBE, KENNETH ETUMUDON (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ETUMUDON
Last Name:OKWUEGBE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25158 VALLEY OAK DR
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-5467
Mailing Address - Country:US
Mailing Address - Phone:510-481-2575
Mailing Address - Fax:
Practice Address - Street 1:25158 VALLEY OAK DR
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94552-5467
Practice Address - Country:US
Practice Address - Phone:510-481-2575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist