Healthcare Provider Details

I. General information

NPI: 1093097776
Provider Name (Legal Business Name): TETEE S KUYATEH PHARM D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2011
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 RHODE ISLAND AVE
FALL RIVER MA
02721-2330
US

IV. Provider business mailing address

328 RHODE ISLAND AVE
FALL RIVER MA
02721-2330
US

V. Phone/Fax

Practice location:
  • Phone: 508-324-9490
  • Fax:
Mailing address:
  • Phone: 508-324-9490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH04789
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH233306
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: