Provider Demographics
NPI:1255621017
Name:YEBOAH, AKWASI G (PHARM D)
Entity type:Individual
Prefix:
First Name:AKWASI
Middle Name:G
Last Name:YEBOAH
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 1:750 QUEEN ANN CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-4730
Mailing Address - Country:US
Mailing Address - Phone:404-297-8770
Mailing Address - Fax:
Practice Address - Street 1:6456 HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:REX
Practice Address - State:GA
Practice Address - Zip Code:30273-1728
Practice Address - Country:US
Practice Address - Phone:770-474-6458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH016960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist