Provider Demographics
NPI:1285216507
Name:OKOYE, BRIGHT UCHENNA
Entity Type:Individual
Prefix:
First Name:BRIGHT
Middle Name:UCHENNA
Last Name:OKOYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 BIENTERRA TRL APT 6
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5807
Mailing Address - Country:US
Mailing Address - Phone:773-431-7295
Mailing Address - Fax:
Practice Address - Street 1:1704 E RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4850
Practice Address - Country:US
Practice Address - Phone:815-633-0475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist