Provider Demographics
NPI:1063949519
Name:OTENG, ASAMOAH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ASAMOAH
Middle Name:
Last Name:OTENG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 BLUE HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1514
Mailing Address - Country:US
Mailing Address - Phone:860-769-6870
Mailing Address - Fax:
Practice Address - Street 1:479 BLUE HILLS AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1514
Practice Address - Country:US
Practice Address - Phone:860-769-6870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0010618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist