Provider Demographics
NPI:1174037766
Name:AMO-BADU, ABENA
Entity Type:Individual
Prefix:
First Name:ABENA
Middle Name:
Last Name:AMO-BADU
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 1:203 WESTERN AVE APT 24
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1431
Mailing Address - Country:US
Mailing Address - Phone:207-356-6443
Mailing Address - Fax:
Practice Address - Street 1:713 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3225
Practice Address - Country:US
Practice Address - Phone:207-942-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-19
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR46971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist