Healthcare Provider Details

I. General information

NPI: 1922814276
Provider Name (Legal Business Name): ALFRED OWUSU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 BUCKLAND RD
SOUTH WINDSOR CT
06074-3746
US

IV. Provider business mailing address

525 BUCKLAND RD
SOUTH WINDSOR CT
06074-3746
US

V. Phone/Fax

Practice location:
  • Phone: 860-644-4241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0015753
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: