Provider Demographics
NPI:1003410390
Name:OWUSU, GABRIEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:OWUSU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7754 JEFFERSON RUN
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8059
Mailing Address - Country:US
Mailing Address - Phone:347-592-5600
Mailing Address - Fax:
Practice Address - Street 1:305 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2124
Practice Address - Country:US
Practice Address - Phone:614-889-6530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03337601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist