Provider Demographics
NPI:1205019502
Name:BOAKYE-DANQUAH, YIADOM KWADWO (RPH)
Entity Type:Individual
Prefix:DR
First Name:YIADOM
Middle Name:KWADWO
Last Name:BOAKYE-DANQUAH
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 1:700 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-864-4189
Mailing Address - Fax:
Practice Address - Street 1:700 COLUMBUS AVE
Practice Address - Street 2:DUANE READE # 202
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6662
Practice Address - Country:US
Practice Address - Phone:212-864-4189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050621183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02735922Medicaid