Healthcare Provider Details

I. General information

NPI: 1033496435
Provider Name (Legal Business Name): ANIWAA OWUSU OBENG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE PHARMACY - BASEMENT
BRONX NY
10457
US

IV. Provider business mailing address

41 WANDEL AVE
STATEN ISLAND NY
10304-1725
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-5020
  • Fax:
Mailing address:
  • Phone: 718-619-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number056139
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: