Provider Demographics
NPI:1306479522
Name:BOATENG, KWAME O (RPH)
Entity type:Individual
Prefix:
First Name:KWAME
Middle Name:O
Last Name:BOATENG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5414 CHAPMANS RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9226
Mailing Address - Country:US
Mailing Address - Phone:704-965-1114
Mailing Address - Fax:
Practice Address - Street 1:1091 MILL CREEK RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9157
Practice Address - Country:US
Practice Address - Phone:610-530-1514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10834183500000X
NC17166183500000X
PARP447363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist