Healthcare Provider Details

I. General information

NPI: 1689282246
Provider Name (Legal Business Name): OBIAGELI ONYESOH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 PASEO DEL PUEBLO SUR
TAOS NM
87571-5966
US

IV. Provider business mailing address

1335 PASEO DEL PUEBLO SUR PMB 143
TAOS NM
87571-5972
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-2743
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010349
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number44089
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number44089
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number44089
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: