Provider Demographics
NPI:1114609260
Name:WAMUCHO, ANYE
Entity Type:Individual
Prefix:
First Name:ANYE
Middle Name:
Last Name:WAMUCHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ASH DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-2256
Mailing Address - Country:US
Mailing Address - Phone:859-987-1210
Mailing Address - Fax:859-987-6928
Practice Address - Street 1:103 ASH DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-2256
Practice Address - Country:US
Practice Address - Phone:859-987-1210
Practice Address - Fax:859-987-6928
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY023703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist