Provider Demographics
NPI:1831789429
Name:BOATENG, CONSTANCE (RPH)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:
Last Name:BOATENG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:
Other - Last Name:AGYEKUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:236 ARBURY DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-4222
Mailing Address - Country:US
Mailing Address - Phone:614-316-5369
Mailing Address - Fax:
Practice Address - Street 1:1710 W GENTRY PKWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-3926
Practice Address - Country:US
Practice Address - Phone:903-595-4179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP455030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist