Provider Demographics
NPI:1558636209
Name:BAM, EMMANUEL KWASI (RPH)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:KWASI
Last Name:BAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 HILLSIDE PARK
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-1124
Mailing Address - Country:US
Mailing Address - Phone:845-837-9233
Mailing Address - Fax:
Practice Address - Street 1:73 HILLSIDE PARK
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-1124
Practice Address - Country:US
Practice Address - Phone:845-837-9233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist