Healthcare Provider Details

I. General information

NPI: 1649451931
Provider Name (Legal Business Name): PETER N GYIMAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2482 GRAND CONCOURSE
BRONX NY
10458-5201
US

IV. Provider business mailing address

1419 NEWKIRK AVE
BROOKLYN NY
11226-6521
US

V. Phone/Fax

Practice location:
  • Phone: 718-483-8144
  • Fax:
Mailing address:
  • Phone: 718-940-1793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051082
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: