Provider Demographics
NPI:1558681635
Name:ADJEPONG, AUGUSTINES
Entity Type:Individual
Prefix:
First Name:AUGUSTINES
Middle Name:
Last Name:ADJEPONG
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 1:9610 57TH AVE APT 18L
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3444
Mailing Address - Country:US
Mailing Address - Phone:718-271-1269
Mailing Address - Fax:
Practice Address - Street 1:10322 CORONA AVE APT 1
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3178
Practice Address - Country:US
Practice Address - Phone:718-271-7486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049634183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy