Healthcare Provider Details

I. General information

NPI: 1538828058
Provider Name (Legal Business Name): LEON OWUSU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BAYVIEW CT
INWOOD NY
11096-2044
US

IV. Provider business mailing address

6 BAYVIEW CT
INWOOD NY
11096-2044
US

V. Phone/Fax

Practice location:
  • Phone: 516-661-0259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number067605I
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: