Provider Demographics
NPI:1578164885
Name:EWUSIE, MARY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:EWUSIE
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 1:2450 W LOOP 338
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-3201
Mailing Address - Country:US
Mailing Address - Phone:432-332-6004
Mailing Address - Fax:432-332-6012
Practice Address - Street 1:2450 WEST LOOP 3378
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763
Practice Address - Country:US
Practice Address - Phone:432-332-6004
Practice Address - Fax:432-332-6012
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist