Provider Demographics
NPI:1982328688
Name:AWAIS, JOSE MIGUEL
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:MIGUEL
Last Name:AWAIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 SW 25TH RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-2202
Mailing Address - Country:US
Mailing Address - Phone:916-489-3638
Mailing Address - Fax:916-489-6304
Practice Address - Street 1:2900 FULTON AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-4910
Practice Address - Country:US
Practice Address - Phone:916-489-3638
Practice Address - Fax:916-489-6304
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH21364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist