Provider Demographics
NPI:1760767834
Name:AZEH, AGNES NJEMA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AGNES
Middle Name:NJEMA
Last Name:AZEH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:99 MARYLAND AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-4528
Mailing Address - Country:US
Mailing Address - Phone:651-487-3319
Mailing Address - Fax:651-487-9794
Practice Address - Street 1:99 MARYLAND AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-4528
Practice Address - Country:US
Practice Address - Phone:651-487-3319
Practice Address - Fax:651-487-9794
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1192191835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy