Provider Demographics
NPI:1023554649
Name:FUKUDA, AYA (PHARMD)
Entity Type:Individual
Prefix:
First Name:AYA
Middle Name:
Last Name:FUKUDA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 VILLAGE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3023
Mailing Address - Country:US
Mailing Address - Phone:512-502-8801
Mailing Address - Fax:512-502-8647
Practice Address - Street 1:7025 VILLAGE CENTER DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3023
Practice Address - Country:US
Practice Address - Phone:512-502-8801
Practice Address - Fax:512-502-8647
Is Sole Proprietor?:No
Enumeration Date:2017-01-07
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist