Healthcare Provider Details

I. General information

NPI: 1164976031
Provider Name (Legal Business Name): BENEDICTA OKOROAFOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 OAKLAWN BLVD
HOPEWELL VA
23860-5032
US

IV. Provider business mailing address

25914 RACING SUN DR
ALDIE VA
20105-5863
US

V. Phone/Fax

Practice location:
  • Phone: 804-458-1231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202214893
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: