Provider Demographics
NPI:1699075176
Name:AYOKOSOK, ERAMBO (PHARM D)
Entity type:Individual
Prefix:
First Name:ERAMBO
Middle Name:
Last Name:AYOKOSOK
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 WALSH CT
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5524
Mailing Address - Country:US
Mailing Address - Phone:307-460-3320
Mailing Address - Fax:
Practice Address - Street 1:1718 WALSH CT
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5524
Practice Address - Country:US
Practice Address - Phone:307-460-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY3349OtherWYOMING STATE BOARD OF PHARMACY