Provider Demographics
NPI:1073900122
Name:OBENG-BOAMPONG, YAW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:YAW
Middle Name:
Last Name:OBENG-BOAMPONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10501 MONTROSE AVE
Mailing Address - Street 2:APT 103
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4141
Mailing Address - Country:US
Mailing Address - Phone:804-714-5669
Mailing Address - Fax:
Practice Address - Street 1:1403 WISCONSIN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2828
Practice Address - Country:US
Practice Address - Phone:202-337-4848
Practice Address - Fax:202-337-9602
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist