Healthcare Provider Details

I. General information

NPI: 1992075949
Provider Name (Legal Business Name): VALANICHE ANICHE OGBONNAYA R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13550 W 9 MILE RD
OAK PARK MI
48237-2852
US

IV. Provider business mailing address

27139 W SKYE DR
FARMINGTON HILLS MI
48334-5340
US

V. Phone/Fax

Practice location:
  • Phone: 313-613-5987
  • Fax: 313-894-0456
Mailing address:
  • Phone: 313-613-5987
  • Fax: 313-894-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302411097
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: