Provider Demographics
NPI:1508468844
Name:OKPALAEZE, GEORGE OKWUDILICHUKWU (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:OKWUDILICHUKWU
Last Name:OKPALAEZE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-2100
Mailing Address - Country:US
Mailing Address - Phone:727-441-6819
Mailing Address - Fax:
Practice Address - Street 1:1803 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-2100
Practice Address - Country:US
Practice Address - Phone:727-441-6819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist