Provider Demographics
NPI:1932923893
Name:ASIEDU, EDWIN WONTUMI (PHARMD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:WONTUMI
Last Name:ASIEDU
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 1:1413 SHADOW BROOK TRL
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1782
Mailing Address - Country:US
Mailing Address - Phone:469-756-6977
Mailing Address - Fax:
Practice Address - Street 1:9937 GARLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3259
Practice Address - Country:US
Practice Address - Phone:214-328-4971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist