Provider Demographics
NPI:1528670288
Name:ADU-GYAMFI, ALEX
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:ADU-GYAMFI
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 1:402 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-3221
Mailing Address - Country:US
Mailing Address - Phone:270-830-6502
Mailing Address - Fax:270-830-7849
Practice Address - Street 1:402 2ND ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3221
Practice Address - Country:US
Practice Address - Phone:270-830-6502
Practice Address - Fax:270-830-7849
Is Sole Proprietor?:No
Enumeration Date:2020-08-23
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY019538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist