Provider Demographics
NPI:1588238745
Name:OFUONYE, OGOCHUKWU VIVIAN
Entity Type:Individual
Prefix:
First Name:OGOCHUKWU
Middle Name:VIVIAN
Last Name:OFUONYE
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 1:11203 184TH PL NE APT D3102
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-7407
Mailing Address - Country:US
Mailing Address - Phone:425-443-0971
Mailing Address - Fax:
Practice Address - Street 1:11203 185TH PL NE
Practice Address - Street 2:D3102
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052
Practice Address - Country:US
Practice Address - Phone:425-443-0971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61105130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist