Provider Demographics
NPI:1215544747
Name:AMOUSSOU, KOFFI MOKPOKPO (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:KOFFI
Middle Name:MOKPOKPO
Last Name:AMOUSSOU
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 QUINTARD AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-5760
Mailing Address - Country:US
Mailing Address - Phone:256-237-6147
Mailing Address - Fax:
Practice Address - Street 1:800 QUINTARD AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-5760
Practice Address - Country:US
Practice Address - Phone:256-237-6147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist