Provider Demographics
NPI:1831967017
Name:OWOHO, IAN LOUIS (PHARMD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:LOUIS
Last Name:OWOHO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:IAN
Other - Middle Name:LOUIS OWOHO
Other - Last Name:OCHIENG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4500 MIXSON AVE APT 627
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-3240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1401 BEN SAWYER BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4574
Practice Address - Country:US
Practice Address - Phone:843-881-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist