Provider Demographics
NPI:1699188425
Name:NKRUMAH, RAYMOND
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:NKRUMAH
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 1:7354 MADELINE CT
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9283
Mailing Address - Country:US
Mailing Address - Phone:734-934-4099
Mailing Address - Fax:
Practice Address - Street 1:25610 PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-8046
Practice Address - Country:US
Practice Address - Phone:248-486-9100
Practice Address - Fax:248-486-5871
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist