Provider Demographics
NPI:1306204367
Name:ASARE-WASSOW, JUANETTA AFIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUANETTA
Middle Name:AFIA
Last Name:ASARE-WASSOW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 W 139TH ST APT 6L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1405
Mailing Address - Country:US
Mailing Address - Phone:202-999-6710
Mailing Address - Fax:
Practice Address - Street 1:45 W 139TH ST APT 6L
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1405
Practice Address - Country:US
Practice Address - Phone:202-999-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0589181835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist