Provider Demographics
NPI:1124629670
Name:ANTOH, MARTIN AMOAKO
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:AMOAKO
Last Name:ANTOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 WALMART DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:DE
Mailing Address - Zip Code:19934-1308
Mailing Address - Country:US
Mailing Address - Phone:302-698-1767
Mailing Address - Fax:302-698-1767
Practice Address - Street 1:263 WALMART DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:DE
Practice Address - Zip Code:19934-1308
Practice Address - Country:US
Practice Address - Phone:302-698-1767
Practice Address - Fax:302-698-9032
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-003407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist