Provider Demographics
NPI:1619356508
Name:OPPONG, KOFI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KOFI
Middle Name:
Last Name:OPPONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 SABLEWOOD RD
Mailing Address - Street 2:APT B
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3415
Mailing Address - Country:US
Mailing Address - Phone:269-757-6787
Mailing Address - Fax:
Practice Address - Street 1:1600 E CHURCHVILLE RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-4804
Practice Address - Country:US
Practice Address - Phone:410-836-9628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-25
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist