Provider Demographics
NPI:1912395559
Name:OWUSU, FRANK ADDO
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:ADDO
Last Name:OWUSU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 MAGNOLIA CREST DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-3862
Mailing Address - Country:US
Mailing Address - Phone:703-598-9488
Mailing Address - Fax:
Practice Address - Street 1:68 MAGNOLIA CREST DR
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3862
Practice Address - Country:US
Practice Address - Phone:703-598-9488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35868183500000X
VA0202213611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist