Provider Demographics
NPI:1467652685
Name:ETTA I. ONYEMAOBIM
Entity Type:Organization
Organization Name:ETTA I. ONYEMAOBIM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYEMAOBIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-327-9862
Mailing Address - Street 1:1304 JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-1950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1304 JUNIPER ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-1950
Practice Address - Country:US
Practice Address - Phone:610-327-9862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042404L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty