Provider Demographics
NPI:1902181449
Name:JUMAH, YAW BOATENG (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:YAW
Middle Name:BOATENG
Last Name:JUMAH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:YAW
Other - Middle Name:BOATENG
Other - Last Name:JUMAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:911 LAKE VIEW AVE APT G
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-8082
Mailing Address - Country:US
Mailing Address - Phone:202-413-0271
Mailing Address - Fax:
Practice Address - Street 1:3251 FREEDOM DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208
Practice Address - Country:US
Practice Address - Phone:704-399-3955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12393183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist