Provider Demographics
NPI:1053324350
Name:AMADI, CLETUS ONYE (RPH)
Entity Type:Individual
Prefix:MR
First Name:CLETUS
Middle Name:ONYE
Last Name:AMADI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MRS
Other - First Name:JANECEIN
Other - Middle Name:IJEOMA
Other - Last Name:AMADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:3050 E DESERT INN RD STE 124
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3873
Mailing Address - Country:US
Mailing Address - Phone:702-697-2105
Mailing Address - Fax:702-697-2107
Practice Address - Street 1:3050 E DESERT INN RAOD
Practice Address - Street 2:STE#124
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3873
Practice Address - Country:US
Practice Address - Phone:702-697-2105
Practice Address - Fax:702-697-2107
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH01798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4405820001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER