Provider Demographics
NPI:1285277574
Name:OKWEREKWU, IKECHUKWU WILLY (RPH)
Entity type:Individual
Prefix:
First Name:IKECHUKWU
Middle Name:WILLY
Last Name:OKWEREKWU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-4318
Mailing Address - Country:US
Mailing Address - Phone:617-981-5147
Mailing Address - Fax:
Practice Address - Street 1:6515 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2708
Practice Address - Country:US
Practice Address - Phone:617-981-5147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-20
Last Update Date:2019-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist