Provider Demographics
NPI:1104107770
Name:OKORONKWO, SAMUEL A (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:A
Last Name:OKORONKWO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:DR
Other - First Name:STELLA
Other - Middle Name:E
Other - Last Name:BASSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:555 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-1949
Mailing Address - Country:US
Mailing Address - Phone:540-381-8713
Mailing Address - Fax:540-381-8717
Practice Address - Street 1:555 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-1949
Practice Address - Country:US
Practice Address - Phone:540-381-8713
Practice Address - Fax:540-381-8717
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29851183500000X
WV0004788183500000X
VA009212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist