Provider Demographics
NPI:1235349903
Name:OKOAWO, OKODUWA ARABOMEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:OKODUWA
Middle Name:ARABOMEN
Last Name:OKOAWO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 NE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-3000
Mailing Address - Country:US
Mailing Address - Phone:954-253-0175
Mailing Address - Fax:
Practice Address - Street 1:590 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1326
Practice Address - Country:US
Practice Address - Phone:305-545-0533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS34767OtherLICENSE NUMBER