Provider Demographics
NPI:1710656194
Name:BOAKYE, BISMARK BANING (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BISMARK
Middle Name:BANING
Last Name:BOAKYE
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 1:501 S LINCOLN AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5901
Mailing Address - Country:US
Mailing Address - Phone:727-447-4248
Mailing Address - Fax:727-445-9604
Practice Address - Street 1:501 S LINCOLN AVE STE 10
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5901
Practice Address - Country:US
Practice Address - Phone:727-447-4248
Practice Address - Fax:727-445-9604
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist