Provider Demographics
NPI:1205208709
Name:OWUSU-AFRIYIE, ELAINE (PHAMD, RPH)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:OWUSU-AFRIYIE
Suffix:
Gender:F
Credentials:PHAMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 W 179TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-2962
Mailing Address - Country:US
Mailing Address - Phone:718-440-0707
Mailing Address - Fax:
Practice Address - Street 1:21 BROAD ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-2309
Practice Address - Country:US
Practice Address - Phone:203-388-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist