Provider Demographics
NPI:1235411778
Name:ONYEOBIA, ENYIOMA E (BPHARM)
Entity Type:Individual
Prefix:MR
First Name:ENYIOMA
Middle Name:E
Last Name:ONYEOBIA
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18301 PULASKI AVE
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2495
Mailing Address - Country:US
Mailing Address - Phone:708-335-4180
Mailing Address - Fax:
Practice Address - Street 1:18301 PULASKI AVE
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2495
Practice Address - Country:US
Practice Address - Phone:708-335-4180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-11
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362127039928Medicaid