Provider Demographics
NPI:1588801575
Name:IKENNA .J. ONUMADU DBA RAPHEM MEDICAL SUPPLY
Entity type:Organization
Organization Name:IKENNA .J. ONUMADU DBA RAPHEM MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IKENNA
Authorized Official - Middle Name:JUNIOR
Authorized Official - Last Name:ONUMADU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-889-1938
Mailing Address - Street 1:8700 COMMERCE PARK DR
Mailing Address - Street 2:#218D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7431
Mailing Address - Country:US
Mailing Address - Phone:713-995-4424
Mailing Address - Fax:
Practice Address - Street 1:8700 COMMERCE PARK DR
Practice Address - Street 2:#218D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7497
Practice Address - Country:US
Practice Address - Phone:713-995-4424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6332940001Medicare NSC