Provider Demographics
NPI:1407369077
Name:AMPOMAAH, WINIFRED AGYEI (PHARMD)
Entity Type:Individual
Prefix:
First Name:WINIFRED
Middle Name:AGYEI
Last Name:AMPOMAAH
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 1:1020 S MESA HILLS DR APT 4903
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5119
Mailing Address - Country:US
Mailing Address - Phone:646-812-5821
Mailing Address - Fax:
Practice Address - Street 1:101 E REDD ROAD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79931
Practice Address - Country:US
Practice Address - Phone:915-206-6140
Practice Address - Fax:915-206-6141
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist