Healthcare Provider Details

I. General information

NPI: 1457955403
Provider Name (Legal Business Name): KWASI BOATENG TWUM-FENING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 S JOHN YOUNG PKWY
ORLANDO FL
32839-7363
US

IV. Provider business mailing address

1117 EAGLE RUN WAY
OCOEE FL
34761-1433
US

V. Phone/Fax

Practice location:
  • Phone: 407-370-2522
  • Fax: 407-370-2522
Mailing address:
  • Phone: 404-538-0409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS52733
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: