Healthcare Provider Details

I. General information

NPI: 1023627536
Provider Name (Legal Business Name): DIANE KENAMEH-NTEINMUSI AYUNINJAM PHARMD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 CORLISS ST
PROVIDENCE RI
02904-2602
US

IV. Provider business mailing address

180 CORLISS ST
PROVIDENCE RI
02904-2602
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-4582
  • Fax:
Mailing address:
  • Phone: 401-793-4582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH06491
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29785
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: