Healthcare Provider Details

I. General information

NPI: 1457064396
Provider Name (Legal Business Name): JOSEPH A OWUSU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8405 SOUTHEASTERN AVE
INDIANAPOLIS IN
46239-1348
US

IV. Provider business mailing address

8405 SOUTHEASTERN AVE
INDIANAPOLIS IN
46239-1348
US

V. Phone/Fax

Practice location:
  • Phone: 317-862-2414
  • Fax: 316-862-1269
Mailing address:
  • Phone: 317-862-2414
  • Fax: 316-862-1269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26030128A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: