Provider Demographics
NPI:1578976114
Name:OKPUKPARA, DAVIDSON CI (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAVIDSON
Middle Name:CI
Last Name:OKPUKPARA
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 1:1630 ROBB DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-3516
Mailing Address - Country:US
Mailing Address - Phone:775-746-6411
Mailing Address - Fax:775-746-6416
Practice Address - Street 1:1630 ROBB DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-3516
Practice Address - Country:US
Practice Address - Phone:775-746-6411
Practice Address - Fax:775-746-6416
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist