Provider Demographics
NPI:1578890729
Name:IMHONDE, OKAIMAN M (RPH)
Entity Type:Individual
Prefix:MS
First Name:OKAIMAN
Middle Name:M
Last Name:IMHONDE
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 1:13022 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5202
Mailing Address - Country:US
Mailing Address - Phone:972-386-4649
Mailing Address - Fax:972-490-6183
Practice Address - Street 1:13022 PRESTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5202
Practice Address - Country:US
Practice Address - Phone:972-386-4649
Practice Address - Fax:972-490-6183
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist