Provider Demographics
NPI:1245889716
Name:SARPONG, KWAKU O (PHARM D)
Entity type:Individual
Prefix:
First Name:KWAKU
Middle Name:O
Last Name:SARPONG
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 1:9140 OLD BUSTLETON AVE APT C306
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4630
Mailing Address - Country:US
Mailing Address - Phone:973-368-3516
Mailing Address - Fax:
Practice Address - Street 1:950 E BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:YEADON
Practice Address - State:PA
Practice Address - Zip Code:19050-2702
Practice Address - Country:US
Practice Address - Phone:610-622-5365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist