Provider Demographics
NPI:1508113275
Name:AWORUWA, AUGUSTINE FELLA (BS PHARM)
Entity Type:Individual
Prefix:MR
First Name:AUGUSTINE
Middle Name:FELLA
Last Name:AWORUWA
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 STATE ROUTE 89N
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323
Mailing Address - Country:US
Mailing Address - Phone:928-636-2986
Mailing Address - Fax:
Practice Address - Street 1:1020 STATE ROUTE 89 NORTH
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323
Practice Address - Country:US
Practice Address - Phone:928-636-2984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist