Provider Demographics
NPI:1508033259
Name:OKONKWO, JOHN OKECHUKWU
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:OKECHUKWU
Last Name:OKONKWO
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 1:1350 E FLORENCE AVE STE BANDC
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-1963
Mailing Address - Country:US
Mailing Address - Phone:323-457-9278
Mailing Address - Fax:323-457-9265
Practice Address - Street 1:1350 E FLORENCE AVE STE BANDC
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-1963
Practice Address - Country:US
Practice Address - Phone:323-457-9278
Practice Address - Fax:323-457-9265
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH57029183500000X
CA57029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist