Provider Demographics
NPI:1093178998
Name:AGYARE, KWESI
Entity Type:Individual
Prefix:
First Name:KWESI
Middle Name:
Last Name:AGYARE
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 1:10295 WV-152
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:WV
Mailing Address - Zip Code:25570
Mailing Address - Country:US
Mailing Address - Phone:202-716-8150
Mailing Address - Fax:
Practice Address - Street 1:10295 WV-152
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:WV
Practice Address - Zip Code:25570
Practice Address - Country:US
Practice Address - Phone:202-716-8150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0009301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist