Healthcare Provider Details

I. General information

NPI: 1972163095
Provider Name (Legal Business Name): IFEANYI VICTOR OKWOR B.PHARM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WINCHESTER DR
LIVERPOOL NY
13088-3530
US

IV. Provider business mailing address

9 WINCHESTER DR
LIVERPOOL NY
13088-3530
US

V. Phone/Fax

Practice location:
  • Phone: 315-378-3081
  • Fax:
Mailing address:
  • Phone: 315-378-3081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04003500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: