Provider Demographics
NPI:1407090384
Name:FOSU, KOFI
Entity Type:Individual
Prefix:MR
First Name:KOFI
Middle Name:
Last Name:FOSU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 FRIEDA LN
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3147
Mailing Address - Country:US
Mailing Address - Phone:937-830-2735
Mailing Address - Fax:
Practice Address - Street 1:4218 FRIEDA LN
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3147
Practice Address - Country:US
Practice Address - Phone:937-830-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-24666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist