Provider Demographics
NPI:1295070613
Name:BOAKYE, TIFFANY ABENA MANU (PHARMD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ABENA MANU
Last Name:BOAKYE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7936 BRESSINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-3157
Mailing Address - Country:US
Mailing Address - Phone:703-495-9749
Mailing Address - Fax:
Practice Address - Street 1:7936 BRESSINGHAM DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-3157
Practice Address - Country:US
Practice Address - Phone:703-495-9749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist