Provider Demographics
NPI:1114527363
Name:BOAMAH-ACHEAMPONG, KOFI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KOFI
Middle Name:
Last Name:BOAMAH-ACHEAMPONG
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 1:4350 SOUTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-8207
Mailing Address - Country:US
Mailing Address - Phone:325-695-9250
Mailing Address - Fax:325-695-7622
Practice Address - Street 1:4350 SOUTHWEST DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-8207
Practice Address - Country:US
Practice Address - Phone:325-695-9250
Practice Address - Fax:325-695-7622
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist