Provider Demographics
NPI:1750049805
Name:AKA, EWEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:EWEN
Middle Name:
Last Name:AKA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4817 CROSS CREEK LN APT B4817
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5777
Mailing Address - Country:US
Mailing Address - Phone:678-887-1199
Mailing Address - Fax:
Practice Address - Street 1:2521 S 6TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-4343
Practice Address - Country:US
Practice Address - Phone:541-883-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0018739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist