Provider Demographics
NPI:1023418381
Name:ABANQUAH, KOFI 0 (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:KOFI
Middle Name:0
Last Name:ABANQUAH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4641 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-4612
Mailing Address - Country:US
Mailing Address - Phone:215-474-5447
Mailing Address - Fax:215-474-5429
Practice Address - Street 1:4641 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-4612
Practice Address - Country:US
Practice Address - Phone:215-474-5447
Practice Address - Fax:215-474-5429
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-23
Last Update Date:2014-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPI003402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist