MEDICARE: DR. DAVID ANTWI BOASIAKO PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	19514	NC
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	19514	NC

General Provider Information

NPI Number	:	1124330113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ANTWI BOASIAKO PHARMD

Provider Business Mailing Address
First Line	:	4220 N TRYON ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-2069
Country	:	US
Telephone Number	:	704-596-8233
Fax Number	:	704-921-1180

Provider Business Practice Location Address
First Line	:	4220 N TRYON ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-2069
Country	:	US
Telephone Number	:	704-596-8233
Fax Number	:	704-921-1180

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	07/08/2010

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