Individual
MRS. FAUSTINA NIYEMAMWEN EVBUOMWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.SC PHARM
Contact information
Practice address
PHARMACY DEPARTMENT, FDIH, JUNCTION OF RT12 & RT 7, FORT DEFIANCE, AZ 86504
(928) 729-8328
(928) 729-8348
Mailing address
PO BOX 1801, FORT DEFIANCE, AZ 86504-1801
(928) 729-2938
(928) 729-8348
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
14355
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
313404259-1
UNITED HEALTHCARE INSURAN
—
Enumeration date
04/26/2007
Last updated
07/08/2007
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