Provider Demographics
NPI:1386327542
Name:AMEYAW, BENEDICTA
Entity type:Individual
Prefix:
First Name:BENEDICTA
Middle Name:
Last Name:AMEYAW
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 1:109 E KNOWLES AVE
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1903
Mailing Address - Country:US
Mailing Address - Phone:484-904-8936
Mailing Address - Fax:
Practice Address - Street 1:119 E BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-2214
Practice Address - Country:US
Practice Address - Phone:610-622-8191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist