Provider Demographics
NPI:1588247134
Name:IFEANYI ARIGUZO, FIDELIS (RPH)
Entity type:Individual
Prefix:
First Name:FIDELIS
Middle Name:
Last Name:IFEANYI ARIGUZO
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 1:6333 E 120TH CT STE A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-8800
Mailing Address - Country:US
Mailing Address - Phone:918-576-6602
Mailing Address - Fax:
Practice Address - Street 1:6333 E 120TH CT STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-8800
Practice Address - Country:US
Practice Address - Phone:918-576-6602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-02
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist