Provider Demographics
NPI:1992075949
Name:OGBONNAYA, VALANICHE ANICHE (RPH)
Entity type:Individual
Prefix:MR
First Name:VALANICHE
Middle Name:ANICHE
Last Name:OGBONNAYA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27139 W SKYE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-5340
Mailing Address - Country:US
Mailing Address - Phone:313-613-5987
Mailing Address - Fax:313-894-0456
Practice Address - Street 1:13550 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2852
Practice Address - Country:US
Practice Address - Phone:313-613-5987
Practice Address - Fax:313-894-0456
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist