Provider Demographics
NPI:1659037794
Name:BOATENG, KWAME (PHARMD)
Entity Type:Individual
Prefix:
First Name:KWAME
Middle Name:
Last Name:BOATENG
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 1:86 WINDING WOOD DR APT 3B
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-2722
Mailing Address - Country:US
Mailing Address - Phone:848-468-3456
Mailing Address - Fax:
Practice Address - Street 1:703 GINESI DR
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1235
Practice Address - Country:US
Practice Address - Phone:732-617-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03882400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist