Provider Demographics
NPI:1215782636
Name:OKON, GRACE NSIKAN
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:NSIKAN
Last Name:OKON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 WOLF CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1658
Mailing Address - Country:US
Mailing Address - Phone:218-206-0938
Mailing Address - Fax:
Practice Address - Street 1:WALGREENS PHARMACY
Practice Address - Street 2:8110 HIGHWAY 100
Practice Address - City:BELLEVUE
Practice Address - State:TN
Practice Address - Zip Code:37221-4214
Practice Address - Country:US
Practice Address - Phone:615-673-1251
Practice Address - Fax:615-673-6489
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70033183500000X
TN42711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist