Provider Demographics
NPI:1326836644
Name:ASUQUO, NDIFREKE (PHARMD)
Entity type:Individual
Prefix:
First Name:NDIFREKE
Middle Name:
Last Name:ASUQUO
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 SOUTHWILDE WAY POOLER
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322
Mailing Address - Country:US
Mailing Address - Phone:404-388-8502
Mailing Address - Fax:404-388-8502
Practice Address - Street 1:1800 BRUNSWICK HWY
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-1061
Practice Address - Country:US
Practice Address - Phone:912-285-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH035408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist