Provider Demographics
NPI:1316220064
Name:BAWUAH, KOFI APPIAH (RPH)
Entity Type:Individual
Prefix:
First Name:KOFI
Middle Name:APPIAH
Last Name:BAWUAH
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 1:3414 MUNDY MILL RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30507-8215
Mailing Address - Country:US
Mailing Address - Phone:770-287-8359
Mailing Address - Fax:
Practice Address - Street 1:3414 MUNDY MILL RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30507-8215
Practice Address - Country:US
Practice Address - Phone:770-287-8359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022868183500000X
VA0202012870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist