Provider Demographics
NPI:1780117689
Name:ANSONG, KWADWO K (PHARMD,BCPS,BCGP,)
Entity type:Individual
Prefix:DR
First Name:KWADWO
Middle Name:K
Last Name:ANSONG
Suffix:
Gender:M
Credentials:PHARMD,BCPS,BCGP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11131 FLANKER WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1935
Mailing Address - Country:US
Mailing Address - Phone:956-525-9461
Mailing Address - Fax:
Practice Address - Street 1:11131 FLANKER WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-1935
Practice Address - Country:US
Practice Address - Phone:956-525-9461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA28671835G0303X
TX455001835P0018X
DC31508951835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy