Provider Demographics
NPI:1336475169
Name:OKONKWO, PATIENCE UNOKO
Entity Type:Individual
Prefix:MRS
First Name:PATIENCE
Middle Name:UNOKO
Last Name:OKONKWO
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 1:3296 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3817
Mailing Address - Country:US
Mailing Address - Phone:910-433-4681
Mailing Address - Fax:910-433-2892
Practice Address - Street 1:3296 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3817
Practice Address - Country:US
Practice Address - Phone:910-433-4681
Practice Address - Fax:910-433-2892
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19452OtherNCBOP