Provider Demographics
NPI:1063152353
Name:ACHEAMPONG, ASANTE (PHARMD)
Entity type:Individual
Prefix:
First Name:ASANTE
Middle Name:
Last Name:ACHEAMPONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:ASANTE
Other - Middle Name:
Other - Last Name:ACHEAMPONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHAARMD
Mailing Address - Street 1:1123 MANITOU DR APT 504
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-5148
Mailing Address - Country:US
Mailing Address - Phone:815-980-5896
Mailing Address - Fax:
Practice Address - Street 1:1105 6TH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2345
Practice Address - Country:US
Practice Address - Phone:231-935-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist