Provider Demographics
NPI:1366042921
Name:OWEREH, ONOME SAMUEL
Entity Type:Individual
Prefix:
First Name:ONOME
Middle Name:SAMUEL
Last Name:OWEREH
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 1:1815 BROTHERS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5413
Mailing Address - Country:US
Mailing Address - Phone:979-693-3095
Mailing Address - Fax:
Practice Address - Street 1:1815 BROTHERS BLVD
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5413
Practice Address - Country:US
Practice Address - Phone:979-693-3841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-31
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist