Lawvet Fonbah Asukwa, RPH

Individual provider Active NPI Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist · Eagle River, WI

NPI 1447884697 · NPPES record last updated Feb 26, 2020

Key facts

NPI
1447884697
Entity type
Individual (NPI type 1)
Primary specialty
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X
License
19719-40 (WI)
Practice address
108 W Wall St
Eagle River, WI 54521-9811
Phone
(715) 479-1069
NPI assigned
Feb 26, 2020
Sex
Male
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
19719-40WIMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co Current
since Apr 10, 2022
Accepting new patients
Walgreen Co Past
since Mar 1, 2020
Accepting new patients

Locations

108 W Wall St
Eagle River, WI 54521
Phone (715) 479-1069

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X 19719-40 WI Yes

Addresses

Primary practice location

108 W Wall St
Eagle River, WI 54521-9811

Mailing address

108 W Wall St
Eagle River, WI 54521-9811
Phone (715) 479-1069

Other providers in Eagle River, WI

All providers in Eagle River, WI · Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Wisconsin

Sources for this page

Verify at the official NPI Registry.