Provider Demographics
NPI:1336745025
Name:OKWARA, JOHN CHUKWUMA
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHUKWUMA
Last Name:OKWARA
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 1:1464 SANTA ANITA BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-4793
Mailing Address - Country:US
Mailing Address - Phone:214-679-2271
Mailing Address - Fax:
Practice Address - Street 1:1750 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4902
Practice Address - Country:US
Practice Address - Phone:903-885-1578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist