Provider Demographics
NPI:1407412901
Name:BOAKYE, EUNICE
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:
Last Name:BOAKYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 PINE ST APT 228
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-8411
Mailing Address - Country:US
Mailing Address - Phone:201-982-5418
Mailing Address - Fax:
Practice Address - Street 1:210 PINE ST APT 228
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-8411
Practice Address - Country:US
Practice Address - Phone:201-982-5418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0014544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist