Active NPI
Jerusah Kwamboka Okwoyo, PHARMD
- Pharmacist
- Indianapolis, IN
National Provider Identifier
1720650666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26029143A
- Practice address
- 3805 S Keystone Ave
Indianapolis, IN 46227-3540 - Phone
- (317) 786-3485
- NPI assigned
- Jul 12, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26029143A | IN | Primary |
Addresses
Primary practice location
3805 S Keystone Ave
Indianapolis, IN 46227-3540
Mailing address
8616 Gulf Dr Apt B
Fort Wayne, IN 46825-6621
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26029143A | IN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626048000000",
"number": "1720650666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8616 GULF DR APT B",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468256621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3805 S KEYSTONE AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462273540",
"telephone_number": "317-786-3485"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OKWOYO",
"first_name": "JERUSAH",
"middle_name": "KWAMBOKA",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-12",
"last_updated": "2021-07-12",
"certification_date": "2021-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26029143A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.