Provider Demographics
NPI:1679174858
Name:OKOLO, CHUKWUMEZIE OKECHUKWU
Entity Type:Individual
Prefix:
First Name:CHUKWUMEZIE
Middle Name:OKECHUKWU
Last Name:OKOLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18900 DALLAS PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6916
Mailing Address - Country:US
Mailing Address - Phone:214-271-5260
Mailing Address - Fax:214-271-5262
Practice Address - Street 1:18900 DALLAS PKWY STE 106
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-6916
Practice Address - Country:US
Practice Address - Phone:214-271-5260
Practice Address - Fax:214-271-5262
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist