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VIDA AWASOM
>> Pharmacist >> Pharmacy Service ProvidersRegistrant NPI Number: 1316549173
Individual Registrant: VIDA AWASOM
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
815 SHUGART RD DALTON, GA 30720-2433 US
Tel: 706-271-2834 Fax: --
Tel: 706-271-2834 Fax: --
Contact information for business:
582 DAWNVILLE RD NE DALTON, GA 30721-8411 US
Tel: -- Fax: --
Tel: -- Fax: --
Registration Information:
NPI: 1316549173
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 183500000X | Pharmacy Service Providers Pharmacist | GA | RPH023966 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
