Provider Demographics
NPI:1316544232
Name:IMORO, AWUDU (PHARMD)
Entity type:Individual
Prefix:
First Name:AWUDU
Middle Name:
Last Name:IMORO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 ASCENSION CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-8537
Mailing Address - Country:US
Mailing Address - Phone:260-206-2811
Mailing Address - Fax:
Practice Address - Street 1:7502 SOUTHTOWN XING
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46816-2515
Practice Address - Country:US
Practice Address - Phone:260-441-7083
Practice Address - Fax:260-441-7085
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025898A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist