Provider Demographics
NPI:1336426675
Name:AWASOM, GERALDINE BIH
Entity Type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:BIH
Last Name:AWASOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12104 E 214TH TER
Mailing Address - Street 2:
Mailing Address - City:PECULIAR
Mailing Address - State:MO
Mailing Address - Zip Code:64078-8322
Mailing Address - Country:US
Mailing Address - Phone:816-679-2214
Mailing Address - Fax:
Practice Address - Street 1:12104 E 214TH TER
Practice Address - Street 2:
Practice Address - City:PECULIAR
Practice Address - State:MO
Practice Address - Zip Code:64078-8322
Practice Address - Country:US
Practice Address - Phone:816-679-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009008798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist