Provider Demographics
NPI:1598011082
Name:OWUSU-AMO, BENFRED
Entity Type:Individual
Prefix:MR
First Name:BENFRED
Middle Name:
Last Name:OWUSU-AMO
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 1:99 S RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-5151
Mailing Address - Country:US
Mailing Address - Phone:603-206-5633
Mailing Address - Fax:603-206-5633
Practice Address - Street 1:99 S RIDGE DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-5151
Practice Address - Country:US
Practice Address - Phone:603-206-5633
Practice Address - Fax:603-206-5633
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR1799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist