Healthcare Provider Details

I. General information

NPI: 1285256917
Provider Name (Legal Business Name): ELIEZER AYETTEY PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PEOPLES PLZ
NEWARK DE
19702-4797
US

IV. Provider business mailing address

400 PEOPLES PLAZA
NEWARK DE
19702
US

V. Phone/Fax

Practice location:
  • Phone: 302-834-0532
  • Fax:
Mailing address:
  • Phone: 302-834-0532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberA1-0005049
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: