Provider Demographics
NPI:1811031586
Name:OPARA, INNOCENT ONYEGBULAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:INNOCENT
Middle Name:ONYEGBULAM
Last Name:OPARA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-4619
Mailing Address - Country:US
Mailing Address - Phone:904-259-1116
Mailing Address - Fax:904-259-1118
Practice Address - Street 1:2261 EDGEWOOD AVE W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-2554
Practice Address - Country:US
Practice Address - Phone:904-924-0615
Practice Address - Fax:904-766-3555
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS00330949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist