Healthcare Provider Details

I. General information

NPI: 1710201090
Provider Name (Legal Business Name): SETH OWUSU RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 3RD AVE FL 4
NEW YORK NY
10017-6706
US

IV. Provider business mailing address

264 WASHINGTON RD
SAYREVILLE NJ
08872-1829
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-5835
  • Fax:
Mailing address:
  • Phone: 732-763-5501
  • Fax: 732-763-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044188
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202204106
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: