Provider Demographics
NPI:1649630179
Name:AKONWAH, WALTER (RPH)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:AKONWAH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31029 BACLAN DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-8271
Mailing Address - Country:US
Mailing Address - Phone:813-728-9332
Mailing Address - Fax:
Practice Address - Street 1:1812 S PARSONS AVE
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-7201
Practice Address - Country:US
Practice Address - Phone:813-685-4444
Practice Address - Fax:813-685-4445
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist