Provider Demographics
NPI:1831539907
Name:SOWELAM, DOAA
Entity type:Individual
Prefix:
First Name:DOAA
Middle Name:
Last Name:SOWELAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 60 74TH STRRET
Mailing Address - Street 2:JACKSON HIGHTS
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:11372
Mailing Address - Country:US
Mailing Address - Phone:646-377-7588
Mailing Address - Fax:
Practice Address - Street 1:3560 74TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-4316
Practice Address - Country:US
Practice Address - Phone:646-377-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist