Provider Demographics
NPI:1316710155
Name:ASAMOAH-ANSAH, ADWOAH AFRAKOMAH
Entity type:Individual
Prefix:
First Name:ADWOAH
Middle Name:AFRAKOMAH
Last Name:ASAMOAH-ANSAH
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 1:860 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2598
Mailing Address - Country:US
Mailing Address - Phone:856-848-5402
Mailing Address - Fax:
Practice Address - Street 1:860 COOPER ST
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-2598
Practice Address - Country:US
Practice Address - Phone:856-848-5402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457910183500000X
NJ28RI04338200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist