Provider Demographics
NPI:1093328205
Name:BOATENG, KWABENA (RPH)
Entity Type:Individual
Prefix:MR
First Name:KWABENA
Middle Name:
Last Name:BOATENG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3016
Mailing Address - Country:US
Mailing Address - Phone:301-577-6222
Mailing Address - Fax:
Practice Address - Street 1:8201 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3016
Practice Address - Country:US
Practice Address - Phone:301-577-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist