Provider Demographics
NPI:1871005363
Name:AWUAH, KWAME FOSU (PHARMD)
Entity Type:Individual
Prefix:
First Name:KWAME
Middle Name:FOSU
Last Name:AWUAH
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 1:1950 AUTO CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6700
Mailing Address - Country:US
Mailing Address - Phone:909-599-3955
Mailing Address - Fax:
Practice Address - Street 1:1950W AUTO CENTRE DR
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6700
Practice Address - Country:US
Practice Address - Phone:909-599-3955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA76957OtherPHARMACIST