Provider Demographics
NPI:1225311467
Name:ANNOH, KWAME (RPH)
Entity Type:Individual
Prefix:MR
First Name:KWAME
Middle Name:
Last Name:ANNOH
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 1:1630 BOSTON TPKE
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:CT
Mailing Address - Zip Code:06238-1205
Mailing Address - Country:US
Mailing Address - Phone:860-742-5389
Mailing Address - Fax:
Practice Address - Street 1:1630 BOSTON TPKE
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:CT
Practice Address - Zip Code:06238-1205
Practice Address - Country:US
Practice Address - Phone:860-742-5389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist