Provider Demographics
NPI:1922601806
Name:ONUORAH, AFOMA MARYSTELLA
Entity Type:Individual
Prefix:
First Name:AFOMA
Middle Name:MARYSTELLA
Last Name:ONUORAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E VINE ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-3620
Mailing Address - Country:US
Mailing Address - Phone:407-846-7858
Mailing Address - Fax:407-846-7161
Practice Address - Street 1:1300 E VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3620
Practice Address - Country:US
Practice Address - Phone:407-846-7858
Practice Address - Fax:407-846-7161
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist