Provider Demographics
NPI:1801346713
Name:MUFORO, GERALD OKECHUKWU (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:OKECHUKWU
Last Name:MUFORO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:GERRY
Other - Middle Name:OKECHUKWU
Other - Last Name:MUFORO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3671 WEST HILLSBOROUGH AVENUE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614
Mailing Address - Country:US
Mailing Address - Phone:813-498-4097
Mailing Address - Fax:
Practice Address - Street 1:3671 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5713
Practice Address - Country:US
Practice Address - Phone:813-498-4097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist