Provider Demographics
NPI:1861862732
Name:BONTI, KWAKU
Entity Type:Individual
Prefix:
First Name:KWAKU
Middle Name:
Last Name:BONTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 BLOSSOM CIR
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5348
Mailing Address - Country:US
Mailing Address - Phone:609-646-8311
Mailing Address - Fax:
Practice Address - Street 1:307 BLOSSOM CIR
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5348
Practice Address - Country:US
Practice Address - Phone:609-646-8311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02610200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist