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General NPI Number Information
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NPI Number | 1326836644
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Entity Type | Individual
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Provider Name | NDIFREKE ASUQUO PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 1800 BRUNSWICK HWY
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City | WAYCROSS
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State | GA
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Zip | 31501-1061
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Country | US
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Telephone | 912-285-2171
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Fax |
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Provider Business Mailing Address
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Address Line | 340 SOUTHWILDE WAY POOLER
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City | POOLER
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State | GA
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Zip | 31322
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Country | US
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Telephone | 404-388-8502
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Fax | 404-388-8502
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH035408
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License Number State | GA
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