Provider Demographics
NPI:1386410090
Name:OKAFOR, JIDEOFOR A
Entity type:Individual
Prefix:
First Name:JIDEOFOR
Middle Name:A
Last Name:OKAFOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4755 WESTHEIMER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-4717
Mailing Address - Country:US
Mailing Address - Phone:713-386-1091
Mailing Address - Fax:
Practice Address - Street 1:4755 WESTHEIMER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-4717
Practice Address - Country:US
Practice Address - Phone:713-386-1091
Practice Address - Fax:713-386-1096
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist