Provider Demographics
NPI:1124330113
Name:BOASIAKO, DAVID ANTWI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTWI
Last Name:BOASIAKO
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 1:4220 N TRYON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-2069
Mailing Address - Country:US
Mailing Address - Phone:704-596-8233
Mailing Address - Fax:704-921-1180
Practice Address - Street 1:4220 N TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-2069
Practice Address - Country:US
Practice Address - Phone:704-596-8233
Practice Address - Fax:704-921-1180
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19514183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist