MEDICARE: CHICHI FOMUNYAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	24836	NV

General Provider Information

NPI Number	:	1093653784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHICHI FOMUNYAM

Provider Business Mailing Address
First Line	:	6755 W ARBY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-4757
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6755 W ARBY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-4757
Country	:	US
Telephone Number	:	405-982-0177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “ CHICHI FOMUNYAM ” Practice Location

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