Healthcare Provider Details

I. General information

NPI: 1497438899
Provider Name (Legal Business Name): DANIEL AYIMBA ONYANGO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 W DOVE VALLEY ROAD PHARMACY PHARMACY
PHOENIX AZ
85085-0013
US

IV. Provider business mailing address

2800 W DOVE VALLEY ROAD PHARMACY PHARMACY
PHOENIX AZ
85085-0013
US

V. Phone/Fax

Practice location:
  • Phone: 480-994-6235
  • Fax:
Mailing address:
  • Phone: 480-994-6235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS026501
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: