Provider Demographics
NPI:1043714660
Name:GYAWU-AMOATENG, SAMUEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:GYAWU-AMOATENG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:SAMUAL
Other - Middle Name:
Other - Last Name:ANTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4033 TALBOT RD S # RS
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5772
Mailing Address - Country:US
Mailing Address - Phone:425-690-3533
Mailing Address - Fax:425-690-9147
Practice Address - Street 1:4033 TALBOT RD S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5772
Practice Address - Country:US
Practice Address - Phone:425-690-3533
Practice Address - Fax:425-690-9147
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0014346183500000X
WAPH61452011183500000X
LAPST.0243371835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835X0200XPharmacy Service ProvidersPharmacistOncology