Provider Demographics
NPI:1346844412
Name:BOAMAH, ELVIS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELVIS
Middle Name:
Last Name:BOAMAH
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 1:2419 NICHOL AVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-3070
Mailing Address - Country:US
Mailing Address - Phone:765-643-4313
Mailing Address - Fax:
Practice Address - Street 1:2419 NICHOL AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-3070
Practice Address - Country:US
Practice Address - Phone:765-643-4313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26026997A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist