MEDICARE: SETH OWUSU RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	044188	NY
2	183500000X	Pharmacist	0202204106	VA

General Provider Information

NPI Number	:	1710201090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SETH OWUSU RPH

Provider Business Mailing Address
First Line	:	264 WASHINGTON RD
Second Line	:
City	:	SAYREVILLE
State	:	NJ
Zip	:	08872-1829
Country	:	US
Telephone Number	:	732-763-5501
Fax Number	:	732-763-5501

Provider Business Practice Location Address
First Line	:	633 3RD AVE FL 4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-6706
Country	:	US
Telephone Number	:	212-639-5835
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2010
Last Update Date	:	03/16/2010

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