Healthcare Provider Details

I. General information

NPI: 1164825436
Provider Name (Legal Business Name): KWADWO OWUSU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 ANDREWS HWY
MIDLAND TX
79701-6331
US

IV. Provider business mailing address

4001 FAUDREE RD APT F304
ODESSA TX
79765-5022
US

V. Phone/Fax

Practice location:
  • Phone: 432-682-8211
  • Fax:
Mailing address:
  • Phone: 229-296-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number55755
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: