Healthcare Provider Details

I. General information

NPI: 1962008748
Provider Name (Legal Business Name): IFEOMA OKAFOR RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2782 N COBB PKWY
KENNESAW GA
30152-3472
US

IV. Provider business mailing address

2670 BINGHAMPTON LN
LAWRENCEVILLE GA
30044-2741
US

V. Phone/Fax

Practice location:
  • Phone: 770-420-1092
  • Fax:
Mailing address:
  • Phone: 678-933-8859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number032201
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: