Healthcare Provider Details

I. General information

NPI: 1376225664
Provider Name (Legal Business Name): ADWOA SASU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 3RD ST
DAYTON OH
45428-9000
US

IV. Provider business mailing address

4100 W 3RD ST
DAYTON OH
45428-9000
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number060001530
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: