Provider Demographics
NPI:1598279408
Name:OKOLI, IFUNANYA (RPH)
Entity Type:Individual
Prefix:
First Name:IFUNANYA
Middle Name:
Last Name:OKOLI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 LAKESHIRE RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-1051
Mailing Address - Country:US
Mailing Address - Phone:713-517-2436
Mailing Address - Fax:
Practice Address - Street 1:2323 N MARTIN LUTHER KING AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-2405
Practice Address - Country:US
Practice Address - Phone:405-424-0557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49320183500000X
OK16071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist