Provider Demographics
NPI:1003581828
Name:EDUSEI, ADWOA (RPH)
Entity Type:Individual
Prefix:
First Name:ADWOA
Middle Name:
Last Name:EDUSEI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 CRIM DELL LANE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182
Mailing Address - Country:US
Mailing Address - Phone:703-334-1379
Mailing Address - Fax:
Practice Address - Street 1:3507 W CARY ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2728
Practice Address - Country:US
Practice Address - Phone:804-256-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist