Provider Demographics
NPI:1598575532
Name:IGHARORO, STEPHANIE OCHUKO
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:OCHUKO
Last Name:IGHARORO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 BAYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-1433
Mailing Address - Country:US
Mailing Address - Phone:575-605-3581
Mailing Address - Fax:
Practice Address - Street 1:3050 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79764-7157
Practice Address - Country:US
Practice Address - Phone:432-332-8470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist