Healthcare Provider Details

I. General information

NPI: 1164546826
Provider Name (Legal Business Name): CYRIL JIDEOFOR OKADIGWE PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 ALLIUM WAY
TAYLORS SC
29687-5461
US

IV. Provider business mailing address

209 ALLIUM WAY
TAYLORS SC
29687-5461
US

V. Phone/Fax

Practice location:
  • Phone: 864-525-6501
  • Fax:
Mailing address:
  • Phone: 864-525-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number008738
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number008738
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number008738
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number008738
License Number StateSC
# 5
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number008738
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: