Provider Demographics
NPI:1417381310
Name:OPARAKUM, JOHNNY (PHARMD)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:OPARAKUM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3217
Mailing Address - Country:US
Mailing Address - Phone:469-853-7759
Mailing Address - Fax:
Practice Address - Street 1:701 W MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6218
Practice Address - Country:US
Practice Address - Phone:469-853-7759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19195183500000X
TX42817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist