Healthcare Provider Details

I. General information

NPI: 1497078505
Provider Name (Legal Business Name): CHRISTIAN KWABENA YEBOAH PHARMACIST.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 GRAY DRIVE - UNIV OF NORTH CAROLINA
GREENSBORO NC
27412-1158
US

IV. Provider business mailing address

8204 CAFFEY DR
COLFAX NC
27235-9647
US

V. Phone/Fax

Practice location:
  • Phone: 336-334-3348
  • Fax: 336-334-3539
Mailing address:
  • Phone: 612-599-5547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20868
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: