Provider Demographics
NPI:1316325822
Name:GHANSAH, EFUA ABAASEWA
Entity type:Individual
Prefix:
First Name:EFUA
Middle Name:ABAASEWA
Last Name:GHANSAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 POND PL
Mailing Address - Street 2:APT 2C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-3627
Mailing Address - Country:US
Mailing Address - Phone:718-503-1373
Mailing Address - Fax:
Practice Address - Street 1:2805 POND PL
Practice Address - Street 2:APT 2C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-3627
Practice Address - Country:US
Practice Address - Phone:718-503-1373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-16
Last Update Date:2015-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY058476OtherPHARMACIST