MEDICARE: MR. BENJAMIN ONWUELEZI R.PH

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	30876	TX

General Provider Information

NPI Number	:	1366779530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN ONWUELEZI R.PH

Provider Business Mailing Address
First Line	:	5001 ROSS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-7706
Country	:	US
Telephone Number	:	214-370-8747
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 ROSS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-7706
Country	:	US
Telephone Number	:	214-370-8747
Fax Number	:

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

Provider Enumeration Date	:	11/09/2009
Last Update Date	:	11/09/2009

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