Provider Demographics
NPI:1184382202
Name:AGYEMANG, MENSAH BOAKYE
Entity type:Individual
Prefix:
First Name:MENSAH
Middle Name:BOAKYE
Last Name:AGYEMANG
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 1:1260 NW 35TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34475-4308
Mailing Address - Country:US
Mailing Address - Phone:352-867-0373
Mailing Address - Fax:352-867-0898
Practice Address - Street 1:1260 NW 35TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-4308
Practice Address - Country:US
Practice Address - Phone:352-867-0373
Practice Address - Fax:352-867-0898
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist