Provider Demographics
NPI:1922381243
Name:BOATENG, DENNIS (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:BOATENG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 CHESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-7017
Mailing Address - Country:US
Mailing Address - Phone:757-739-5857
Mailing Address - Fax:
Practice Address - Street 1:3376 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5620
Practice Address - Country:US
Practice Address - Phone:757-340-8013
Practice Address - Fax:757-340-8154
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208386183500000X
CTPCT.0011094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist