Provider Demographics
NPI:1437436516
Name:ONYENWE, MARYJANE C (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARYJANE
Middle Name:C
Last Name:ONYENWE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:MARYJANE
Other - Middle Name:C
Other - Last Name:ONYENWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2442 SW 156TH AVE FL 33027
Mailing Address - Street 2:SAME AS ABOVE
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4275
Mailing Address - Country:US
Mailing Address - Phone:954-304-1025
Mailing Address - Fax:
Practice Address - Street 1:2442 SW 156TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027
Practice Address - Country:US
Practice Address - Phone:954-304-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL33846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist