Provider Demographics
NPI:1093474892
Name:AMAGYEI, KELVIN NANA BONSU (PH240580)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:NANA BONSU
Last Name:AMAGYEI
Suffix:
Gender:M
Credentials:PH240580
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-3209
Mailing Address - Country:US
Mailing Address - Phone:413-774-2201
Mailing Address - Fax:413-774-6251
Practice Address - Street 1:107 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3209
Practice Address - Country:US
Practice Address - Phone:413-774-2201
Practice Address - Fax:413-774-6254
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist