Healthcare Provider Details

I. General information

NPI: 1770412868
Provider Name (Legal Business Name): PATRICK AYITEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 TENNYSON AVE APT 142
EUGENE OR
97408-7595
US

IV. Provider business mailing address

2845 TENNYSON AVE APT 142
EUGENE OR
97408-7595
US

V. Phone/Fax

Practice location:
  • Phone: 219-286-0713
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0021045
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: