Provider Demographics
NPI:1396811469
Name:AHHING FAAIUASO, EVELYN C (PHARM P)
Entity type:Individual
Prefix:MISS
First Name:EVELYN
Middle Name:C
Last Name:AHHING FAAIUASO
Suffix:
Gender:F
Credentials:PHARM P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 TURNER ROAD
Mailing Address - Street 2:LBJ TROPICAL MEDICAL CENTER
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799
Mailing Address - Country:US
Mailing Address - Phone:684-633-2003
Mailing Address - Fax:684-633-2002
Practice Address - Street 1:1234 TURNER ROAD
Practice Address - Street 2:LBJ TROPICAL MEDICAL CENTER
Practice Address - City:FAAGACLA
Practice Address - State:AS
Practice Address - Zip Code:96799
Practice Address - Country:US
Practice Address - Phone:684-633-1222
Practice Address - Fax:684-633-2002
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2008-01-14
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-01-14
Provider Licenses
StateLicense IDTaxonomies
HIPH-1797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist