Provider Demographics
NPI:1417176751
Name:OKOH, ISAIAH ETUONU (RPH)
Entity Type:Individual
Prefix:
First Name:ISAIAH
Middle Name:ETUONU
Last Name:OKOH
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 1:29048 GLOEDE DR
Mailing Address - Street 2:APT. 1
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4012
Mailing Address - Country:US
Mailing Address - Phone:586-585-9676
Mailing Address - Fax:586-585-9676
Practice Address - Street 1:14820 MACK AVE
Practice Address - Street 2:RITE AID PHARMACY #7758
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2526
Practice Address - Country:US
Practice Address - Phone:313-331-1038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist