Provider Demographics
NPI:1457636946
Name:AWUAH, EUGENE
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:
Last Name:AWUAH
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 1:2048 ROYAL ASCOT WAY
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-8262
Mailing Address - Country:US
Mailing Address - Phone:209-341-0814
Mailing Address - Fax:
Practice Address - Street 1:2048 ROYAL ASCOT WAY
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361
Practice Address - Country:US
Practice Address - Phone:209-341-0814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist