Provider Demographics
NPI:1447884697
Name:ASUKWA, LAWVET FONBAH (RPH)
Entity type:Individual
Prefix:
First Name:LAWVET
Middle Name:FONBAH
Last Name:ASUKWA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W WALL ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54521-9811
Mailing Address - Country:US
Mailing Address - Phone:715-479-1069
Mailing Address - Fax:715-479-1370
Practice Address - Street 1:108 W WALL ST
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:WI
Practice Address - Zip Code:54521-9811
Practice Address - Country:US
Practice Address - Phone:715-479-1069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19719-401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist