Provider Demographics
NPI: | 1013168533 |
---|---|
Name: | OKWONNA, ALEXANDER C (PHARMD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ALEXANDER |
Middle Name: | C |
Last Name: | OKWONNA |
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: | 12206 BECKFIELD CT |
Mailing Address - Street 2: | |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77099-3811 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 832-657-1906 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5402 BALMORHEA DR |
Practice Address - Street 2: | |
Practice Address - City: | PEARLAND |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77584-1449 |
Practice Address - Country: | US |
Practice Address - Phone: | 832-496-1977 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2008-10-02 |
Last Update Date: | 2014-02-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 42116 | 183500000X, 1835G0303X, 1835P0018X, 1835P1200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 183500000X | Pharmacy Service Providers | Pharmacist | |
No | 1835G0303X | Pharmacy Service Providers | Pharmacist | Geriatric |
No | 1835P0018X | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No | 1835P1200X | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |