Provider Demographics
NPI:1437449683
Name:DUWON, ANGURO
Entity Type:Individual
Prefix:
First Name:ANGURO
Middle Name:
Last Name:DUWON
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 1:833 SOUTH SALISBURY BLVD
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801
Mailing Address - Country:US
Mailing Address - Phone:443-260-0722
Mailing Address - Fax:443-260-0776
Practice Address - Street 1:833 SOUTH SALISBURY BLVD
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:443-260-0722
Practice Address - Fax:443-260-0776
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist