Provider Demographics
NPI:1225431265
Name:NTI-BOADU, KOJO (PHARM D)
Entity Type:Individual
Prefix:
First Name:KOJO
Middle Name:
Last Name:NTI-BOADU
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10095 WASHINGTON BLVD N APT 314
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1952
Mailing Address - Country:US
Mailing Address - Phone:716-316-1006
Mailing Address - Fax:
Practice Address - Street 1:8302 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-3124
Practice Address - Country:US
Practice Address - Phone:410-655-9890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-05
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist