Healthcare Provider Details

I. General information

NPI: 1669796801
Provider Name (Legal Business Name): KWAME YIADOM PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 12/18/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 MEDICAL CENTER ROAD
FORT CAVAZOS TX
76544
US

IV. Provider business mailing address

305 WROUGHT IRON DR
HARKER HEIGHTS TX
76548-7495
US

V. Phone/Fax

Practice location:
  • Phone: 254-288-8800
  • Fax:
Mailing address:
  • Phone: 254-419-1029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH233354
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: