Provider Demographics
NPI:1326563099
Name:FREMPONG, EDWARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:FREMPONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46965 CEDAR LAKE PLZ
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-8653
Mailing Address - Country:US
Mailing Address - Phone:703-430-3328
Mailing Address - Fax:
Practice Address - Street 1:46965 CEDAR LAKE PLZ
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-8653
Practice Address - Country:US
Practice Address - Phone:703-430-3328
Practice Address - Fax:703-430-8203
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202216070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist