1396811469 NPI number — MISS EVELYN C AHHING FAAIUASO PHARM P

Table of content: MISS EVELYN C AHHING FAAIUASO PHARM P (NPI 1396811469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396811469 NPI number — MISS EVELYN C AHHING FAAIUASO PHARM P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHHING FAAIUASO
Provider First Name:
EVELYN
Provider Middle Name:
C
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PHARM P
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396811469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
01/14/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1234 TURNER ROAD
Provider Second Line Business Mailing Address:
LBJ TROPICAL MEDICAL CENTER
Provider Business Mailing Address City Name:
PAGO PAGO
Provider Business Mailing Address State Name:
AS
Provider Business Mailing Address Postal Code:
96799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
684-633-2003
Provider Business Mailing Address Fax Number:
684-633-2002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1234 TURNER ROAD
Provider Second Line Business Practice Location Address:
LBJ TROPICAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
FAAGACLA
Provider Business Practice Location Address State Name:
AS
Provider Business Practice Location Address Postal Code:
96799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
684-633-1222
Provider Business Practice Location Address Fax Number:
684-633-2002
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PH-1797 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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