Healthcare Provider Details

I. General information

NPI: 1487934626
Provider Name (Legal Business Name): JOHN AGYEMANG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER CMR 405 BOX 7688
APO AE
09034-7688
US

IV. Provider business mailing address

CMR 405 BOX 7688
APO AE
09034
US

V. Phone/Fax

Practice location:
  • Phone: 496371857220
  • Fax:
Mailing address:
  • Phone: 496371867220
  • Fax: 496371857220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP444864
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03165100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18567
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPCT 9925
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: