Provider Demographics
NPI:1679283626
Name:AMOAH, KOBINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KOBINA
Middle Name:
Last Name:AMOAH
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 1:1452 SILVER CHARM LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-0114
Mailing Address - Country:US
Mailing Address - Phone:404-704-2288
Mailing Address - Fax:
Practice Address - Street 1:2781 LAVISTA RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-1713
Practice Address - Country:US
Practice Address - Phone:404-929-1013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist