Provider Demographics
NPI:1619279122
Name:AMOSAH, NELLI SIMONIAN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:NELLI
Middle Name:SIMONIAN
Last Name:AMOSAH
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HOLLY HILL CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-6504
Mailing Address - Country:US
Mailing Address - Phone:336-923-5343
Mailing Address - Fax:
Practice Address - Street 1:1327 MEADOWLARK DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-9817
Practice Address - Country:US
Practice Address - Phone:336-922-7066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist