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General NPI Number Information
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NPI Number | 1588298830
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Entity Type | Individual
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Provider Name | FIDELIS ONOH
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Gender | Male
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 1604 E SPRUCE ST
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City | PORTALES
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State | NM
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Zip | 88130-9489
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Country | US
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Telephone | 575-359-3420
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Fax |
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Provider Business Mailing Address
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Address Line | 840 MOLTEN PL NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-1742
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Country | US
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Telephone | 505-559-3940
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP00009245
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License Number State | NM
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