Provider Demographics
NPI:1588298830
Name:ONOH, FIDELIS
Entity type:Individual
Prefix:
First Name:FIDELIS
Middle Name:
Last Name:ONOH
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 1:840 MOLTEN PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1742
Mailing Address - Country:US
Mailing Address - Phone:505-559-3940
Mailing Address - Fax:
Practice Address - Street 1:1604 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-9489
Practice Address - Country:US
Practice Address - Phone:575-359-3420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist