Provider Demographics
NPI:1629392485
Name:KWOKA, MATTHEW FRANK (BS)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:FRANK
Last Name:KWOKA
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14360 243RD ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2340
Mailing Address - Country:US
Mailing Address - Phone:718-276-0274
Mailing Address - Fax:
Practice Address - Street 1:14360 243RD ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2340
Practice Address - Country:US
Practice Address - Phone:718-276-0274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist