Provider Demographics
NPI:1245815679
Name:BOATENG, KWASI KARIKARI
Entity type:Individual
Prefix:MR
First Name:KWASI
Middle Name:KARIKARI
Last Name:BOATENG
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 1:99 GRANGER BLVD
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-2855
Mailing Address - Country:US
Mailing Address - Phone:774-239-1439
Mailing Address - Fax:
Practice Address - Street 1:99 GRANGER BLVD
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-2855
Practice Address - Country:US
Practice Address - Phone:508-229-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT25248183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician