Provider Demographics
NPI:1508404948
Name:ADDAE-AFOAKWA, KWAME NTI
Entity Type:Individual
Prefix:
First Name:KWAME
Middle Name:NTI
Last Name:ADDAE-AFOAKWA
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 1:117 MAJESTIC FOREST RUN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7172
Mailing Address - Country:US
Mailing Address - Phone:407-325-5492
Mailing Address - Fax:
Practice Address - Street 1:902 LEE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-5561
Practice Address - Country:US
Practice Address - Phone:407-204-8739
Practice Address - Fax:407-204-8738
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49153183500000X
FLPS53601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist