Provider Demographics
NPI:1740622265
Name:ANANE, YAW BOATENG (PHARMD)
Entity type:Individual
Prefix:
First Name:YAW
Middle Name:BOATENG
Last Name:ANANE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6455 HIDDEN LAKE LOOP
Mailing Address - Street 2:APT 133
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-0393
Mailing Address - Country:US
Mailing Address - Phone:559-375-9806
Mailing Address - Fax:
Practice Address - Street 1:3296 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3817
Practice Address - Country:US
Practice Address - Phone:910-433-4681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC236651835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC23665OtherPHARMACIST LICENSE