Provider Demographics
NPI:1770188559
Name:AMEYAW, SAMUEL KWAME
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:KWAME
Last Name:AMEYAW
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 1:63 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-3252
Mailing Address - Country:US
Mailing Address - Phone:508-865-8805
Mailing Address - Fax:
Practice Address - Street 1:63 CANAL ST
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-3252
Practice Address - Country:US
Practice Address - Phone:508-865-8805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist