Provider Demographics
NPI:1447913785
Name:OKWUCHI, BASILIA
Entity type:Individual
Prefix:
First Name:BASILIA
Middle Name:
Last Name:OKWUCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8002 RIVER FIELD CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3305
Mailing Address - Country:US
Mailing Address - Phone:240-486-2986
Mailing Address - Fax:
Practice Address - Street 1:8301 PROFESSIONAL PL
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2237
Practice Address - Country:US
Practice Address - Phone:703-216-0896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist