Provider Demographics
NPI:1972885663
Name:NWAFOR, CYPRIAN
Entity Type:Individual
Prefix:
First Name:CYPRIAN
Middle Name:
Last Name:NWAFOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 N STATELINE AVE
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3138
Mailing Address - Country:US
Mailing Address - Phone:903-792-8918
Mailing Address - Fax:903-792-6198
Practice Address - Street 1:4415 N STATELINE AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3138
Practice Address - Country:US
Practice Address - Phone:903-792-8918
Practice Address - Fax:903-792-6198
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist