Healthcare Provider Details

I. General information

NPI: 1598279408
Provider Name (Legal Business Name): IFUNANYA OKOLI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 11/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 N MARTIN LUTHER KING AVE
OKLAHOMA CITY OK
73111-2405
US

IV. Provider business mailing address

3008 LAKESHIRE RIDGE WAY
EDMOND OK
73034-1051
US

V. Phone/Fax

Practice location:
  • Phone: 405-424-0557
  • Fax:
Mailing address:
  • Phone: 713-517-2436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number49320
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16071
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: