Healthcare Provider Details

I. General information

NPI: 1144808189
Provider Name (Legal Business Name): ANTHONY I OKAFOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 WAUGHTOWN ST
WINSTON SALEM NC
27107-2217
US

IV. Provider business mailing address

658 WAUGHTOWN ST
WINSTON SALEM NC
27107-2217
US

V. Phone/Fax

Practice location:
  • Phone: 336-893-6286
  • Fax:
Mailing address:
  • Phone: 336-893-6286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18748
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: