Provider Demographics
NPI:1598377285
Name:OPOKU, KWAME AIDOO (RPH)
Entity Type:Individual
Prefix:
First Name:KWAME
Middle Name:AIDOO
Last Name:OPOKU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9824 MERCER ESTATES CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-8758
Mailing Address - Country:US
Mailing Address - Phone:702-481-7499
Mailing Address - Fax:
Practice Address - Street 1:4930 BLUE DIAMOND RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-7604
Practice Address - Country:US
Practice Address - Phone:702-260-9695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-23
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist