Healthcare Provider Details

I. General information

NPI: 1285268508
Provider Name (Legal Business Name): SERWAA OWUSU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2935 RIDGE RD
ROCKWALL TX
75032-5804
US

IV. Provider business mailing address

2935 RIDGE RD
ROCKWALL TX
75032-5804
US

V. Phone/Fax

Practice location:
  • Phone: 972-882-1366
  • Fax:
Mailing address:
  • Phone: 972-882-1266
  • Fax: 972-882-1251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number41287
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: