Provider Demographics
NPI:1659658755
Name:BAMFO-AGYEI, AKUA S (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AKUA
Middle Name:S
Last Name:BAMFO-AGYEI
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 1:7111 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60636-3614
Mailing Address - Country:US
Mailing Address - Phone:630-865-6473
Mailing Address - Fax:
Practice Address - Street 1:7111 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60636-3614
Practice Address - Country:US
Practice Address - Phone:630-865-6473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist