Provider Demographics
NPI:1164705240
Name:BOATENG, KWAME ASANTE (RPH)
Entity Type:Individual
Prefix:MR
First Name:KWAME
Middle Name:ASANTE
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 1:901 RAAD CT
Mailing Address - Street 2:
Mailing Address - City:FT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5951
Mailing Address - Country:US
Mailing Address - Phone:301-292-8789
Mailing Address - Fax:301-449-6575
Practice Address - Street 1:6300 CRAIN HWY
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-4259
Practice Address - Country:US
Practice Address - Phone:301-392-6116
Practice Address - Fax:301-392-1544
Is Sole Proprietor?:No
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist