Healthcare Provider Details

I. General information

NPI: 1487149902
Provider Name (Legal Business Name): EMMANUEL OWUSU-AMANKWAH PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE ROOM K-135
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

300 ALUMNI DR APT 240
LEXINGTON KY
40503-1649
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5855
  • Fax:
Mailing address:
  • Phone: 413-695-6746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number019677
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03337692
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: