Provider Demographics
NPI:1669678652
Name:BOATENG, KWABENA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KWABENA
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 1:12513 HIGHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-5726
Mailing Address - Country:US
Mailing Address - Phone:904-641-9825
Mailing Address - Fax:904-261-3796
Practice Address - Street 1:1525 SADLER RD
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4467
Practice Address - Country:US
Practice Address - Phone:904-261-2663
Practice Address - Fax:904-261-3796
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist