Provider Demographics
NPI:1063821635
Name:BOAKYE, PRINCE
Entity type:Individual
Prefix:DR
First Name:PRINCE
Middle Name:
Last Name:BOAKYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N MYRTLE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-1257
Mailing Address - Country:US
Mailing Address - Phone:704-864-6670
Mailing Address - Fax:704-864-6660
Practice Address - Street 1:223 N MYRTLE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-1257
Practice Address - Country:US
Practice Address - Phone:704-864-6670
Practice Address - Fax:704-864-6660
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16695183500000X
SC10571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist