Healthcare Provider Details

I. General information

NPI: 1336745025
Provider Name (Legal Business Name): JOHN CHUKWUMA OKWARA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

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

1750 S BROADWAY ST
SULPHUR SPRINGS TX
75482-4902
US

IV. Provider business mailing address

1464 SANTA ANITA BLVD
IRVING TX
75060-4793
US

V. Phone/Fax

Practice location:
  • Phone: 903-885-1578
  • Fax:
Mailing address:
  • Phone: 214-679-2271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45887
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: