Provider Demographics
NPI:1104421973
Name:OSUAGWU, PATIENCE
Entity type:Individual
Prefix:DR
First Name:PATIENCE
Middle Name:
Last Name:OSUAGWU
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 1:408 WILLOWS LN
Mailing Address - Street 2:
Mailing Address - City:ALDAN
Mailing Address - State:PA
Mailing Address - Zip Code:19018-3135
Mailing Address - Country:US
Mailing Address - Phone:215-435-2651
Mailing Address - Fax:
Practice Address - Street 1:1306 MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:WOODLYN
Practice Address - State:PA
Practice Address - Zip Code:19094-1501
Practice Address - Country:US
Practice Address - Phone:610-521-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist