Provider Demographics
NPI:1508033259
Name:OKONKWO, JOHN OKECHUKWU
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:OKECHUKWU
Last Name:OKONKWO
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 1:10631 TIERRASANTA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2605
Mailing Address - Country:US
Mailing Address - Phone:858-576-0972
Mailing Address - Fax:858-576-0035
Practice Address - Street 1:10631 TIERRASANTA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-2605
Practice Address - Country:US
Practice Address - Phone:858-576-0972
Practice Address - Fax:858-576-0035
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH57029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist