Provider Demographics
NPI:1376233627
Name:AWJAMA, HUSSEIN
Entity type:Individual
Prefix:
First Name:HUSSEIN
Middle Name:
Last Name:AWJAMA
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 1:1351 HAMPSHIRE AVE S APT 123
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-2241
Mailing Address - Country:US
Mailing Address - Phone:612-584-3374
Mailing Address - Fax:
Practice Address - Street 1:912 E 24TH ST STE B102
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3876
Practice Address - Country:US
Practice Address - Phone:651-273-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist