Provider Demographics
NPI:1174193932
Name:BAAH-WILLIAMS, BLENKELL ANTWI (PHARMD)
Entity Type:Individual
Prefix:
First Name:BLENKELL
Middle Name:ANTWI
Last Name:BAAH-WILLIAMS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19B FRIEDEN MNR
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972-9507
Mailing Address - Country:US
Mailing Address - Phone:347-636-3908
Mailing Address - Fax:
Practice Address - Street 1:26 W INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-5314
Practice Address - Country:US
Practice Address - Phone:570-648-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP455020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP455020OtherPHARMACIST
PARPI014319OtherIMMUNIZATION