Provider Demographics
NPI:1659640613
Name:AIFUWA, DORIS O (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DORIS
Middle Name:O
Last Name:AIFUWA
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 1:6510 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-2748
Mailing Address - Country:US
Mailing Address - Phone:219-931-3332
Mailing Address - Fax:219-852-9201
Practice Address - Street 1:6510 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-2748
Practice Address - Country:US
Practice Address - Phone:219-931-3332
Practice Address - Fax:219-852-9201
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019439A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist