Provider Demographics
NPI:1598434516
Name:OKAFOR, IKENNA B (PHARMD)
Entity Type:Individual
Prefix:
First Name:IKENNA
Middle Name:B
Last Name:OKAFOR
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 1:1525 COVERED WAGON RD
Mailing Address - Street 2:
Mailing Address - City:MC LEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301-9699
Mailing Address - Country:US
Mailing Address - Phone:336-456-0620
Mailing Address - Fax:
Practice Address - Street 1:304 E ARBOR LN
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5396
Practice Address - Country:US
Practice Address - Phone:336-623-6494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist