Healthcare Provider Details

I. General information

NPI: 1598011082
Provider Name (Legal Business Name): MR. BENFRED OWUSU-AMO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 S RIDGE DR
MANCHESTER NH
03109-5151
US

IV. Provider business mailing address

99 S RIDGE DR
MANCHESTER NH
03109-5151
US

V. Phone/Fax

Practice location:
  • Phone: 603-206-5633
  • Fax: 603-206-5633
Mailing address:
  • Phone: 603-206-5633
  • Fax: 603-206-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR1799
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: