Provider Demographics
NPI:1073059747
Name:ANGUAH, THEOPHILUS KWABENA
Entity Type:Individual
Prefix:
First Name:THEOPHILUS
Middle Name:KWABENA
Last Name:ANGUAH
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:F4. EMEFS HILLVIEW PALACE
Mailing Address - Street 2:
Mailing Address - City:TEMA
Mailing Address - State:NA
Mailing Address - Zip Code:NA
Mailing Address - Country:GH
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:606 HOMER RD
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-2910
Practice Address - Country:US
Practice Address - Phone:318-377-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist