Provider Demographics
NPI:1457955403
Name:TWUM-FENING, KWASI BOATENG
Entity Type:Individual
Prefix:
First Name:KWASI
Middle Name:BOATENG
Last Name:TWUM-FENING
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 1:1117 EAGLE RUN WAY
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-1433
Mailing Address - Country:US
Mailing Address - Phone:404-538-0409
Mailing Address - Fax:
Practice Address - Street 1:5300 S JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-7363
Practice Address - Country:US
Practice Address - Phone:407-370-2522
Practice Address - Fax:407-370-2522
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist