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: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046B HERCULES AVE
HOUSTON TX
77058-2722
US

IV. Provider business mailing address

1300 W 19TH ST # 7412
HOUSTON TX
77008-1689
US

V. Phone/Fax

Practice location:
  • Phone: 281-480-0327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: