Provider Demographics
NPI:1265038517
Name:OKORIE, NGOZI KOKO (RPH)
Entity Type:Individual
Prefix:
First Name:NGOZI
Middle Name:KOKO
Last Name:OKORIE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 FAWN MEADOW TRL
Mailing Address - Street 2:
Mailing Address - City:KENNEDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76060-5837
Mailing Address - Country:US
Mailing Address - Phone:817-478-7309
Mailing Address - Fax:
Practice Address - Street 1:1100 N WALNUT CREEK DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2502
Practice Address - Country:US
Practice Address - Phone:817-473-0271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist