Provider Demographics
NPI:1578712998
Name:KUFFOUR, NANA AMA AGYEIWAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:NANA AMA
Middle Name:AGYEIWAH
Last Name:KUFFOUR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 SW KECK DR
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6691
Mailing Address - Country:US
Mailing Address - Phone:503-474-0894
Mailing Address - Fax:
Practice Address - Street 1:615 SW KECK DR
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6691
Practice Address - Country:US
Practice Address - Phone:503-474-0894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0011156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist