Provider Demographics
NPI:1083294508
Name:ONYEMAH, OBINNA PRINCE
Entity Type:Individual
Prefix:
First Name:OBINNA
Middle Name:PRINCE
Last Name:ONYEMAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 UNION ST APT 11
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-2607
Mailing Address - Country:US
Mailing Address - Phone:781-975-9337
Mailing Address - Fax:
Practice Address - Street 1:58 UNION ST APT 11
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-2607
Practice Address - Country:US
Practice Address - Phone:781-975-9337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT1618183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA100048034704Medicaid