Provider Demographics
NPI:1346924909
Name:ASIEDU, GIDEON
Entity Type:Individual
Prefix:
First Name:GIDEON
Middle Name:
Last Name:ASIEDU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 MAIN ST APT 203
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2053
Mailing Address - Country:US
Mailing Address - Phone:774-208-2948
Mailing Address - Fax:
Practice Address - Street 1:481 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1915
Practice Address - Country:US
Practice Address - Phone:508-852-3578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH241520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist