Provider Demographics
NPI:1457951170
Name:MBADIKE, OKEY PATRICK (PHARNCIST)
Entity Type:Individual
Prefix:
First Name:OKEY
Middle Name:PATRICK
Last Name:MBADIKE
Suffix:
Gender:M
Credentials:PHARNCIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 BUECHAL BY PASS, LOUISVILLE, KY 40218
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218
Mailing Address - Country:US
Mailing Address - Phone:502-458-9511
Mailing Address - Fax:502-456-9285
Practice Address - Street 1:3616 BUECHAL BY PASS, LOUISVILLE, KY 40218
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218
Practice Address - Country:US
Practice Address - Phone:502-458-9511
Practice Address - Fax:502-456-9285
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist