Healthcare Provider Details

I. General information

NPI: 1457539397
Provider Name (Legal Business Name): ALEXIAN B ONYENSO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2008
Last Update Date: 01/01/2025
Certification Date: 01/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12012 N 111TH AVE
YOUNGTOWN AZ
85363-1339
US

IV. Provider business mailing address

8688 E RAINTREE DR APT 1039
SCOTTSDALE AZ
85260-0013
US

V. Phone/Fax

Practice location:
  • Phone: 480-258-2339
  • Fax:
Mailing address:
  • Phone: 480-258-2339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS024424
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: