MEDICARE: DR. AGNES NJEMA AZEH PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	119219	MN

General Provider Information

NPI Number	:	1760767834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AGNES NJEMA AZEH PHARMD

Provider Business Mailing Address
First Line	:	99 MARYLAND AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-4528
Country	:	US
Telephone Number	:	651-487-3319
Fax Number	:	651-487-9794

Provider Business Practice Location Address
First Line	:	99 MARYLAND AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-4528
Country	:	US
Telephone Number	:	651-487-3319
Fax Number	:	651-487-9794

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	10/19/2011

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