Healthcare Provider Details

I. General information

NPI: 1023711249
Provider Name (Legal Business Name): JOSEPHINE OWUSU-BOAKYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8027 KITTY HAWK RD
CONVERSE TX
78109-2526
US

IV. Provider business mailing address

25007 PLAYER OAKS
SAN ANTONIO TX
78260-7222
US

V. Phone/Fax

Practice location:
  • Phone: 210-566-3615
  • Fax:
Mailing address:
  • Phone: 361-945-3334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65655
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: