Provider Demographics
NPI:1851610679
Name:AYIM BEDIAKO, ABENA BEMPOMAA (RPH)
Entity Type:Individual
Prefix:
First Name:ABENA
Middle Name:BEMPOMAA
Last Name:AYIM BEDIAKO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 EDMONTON TER NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1829
Mailing Address - Country:US
Mailing Address - Phone:571-232-1120
Mailing Address - Fax:
Practice Address - Street 1:609 E MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3182
Practice Address - Country:US
Practice Address - Phone:540-338-4195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist