Provider Demographics
NPI:1366714149
Name:OKAFOR, THEODORA A (PHARM D)
Entity type:Individual
Prefix:DR
First Name:THEODORA
Middle Name:A
Last Name:OKAFOR
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:THEODORA
Other - Middle Name:N
Other - Last Name:ADIMKPAYAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:5365 WALNUT AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2622
Mailing Address - Country:US
Mailing Address - Phone:909-591-6038
Mailing Address - Fax:909-591-4709
Practice Address - Street 1:5365 WALNUT AVE STE D
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2622
Practice Address - Country:US
Practice Address - Phone:909-591-6038
Practice Address - Fax:909-591-4709
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38091183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA389360Medicaid
CA1145060001Medicare NSC