Healthcare Provider Details

I. General information

NPI: 1780117689
Provider Name (Legal Business Name): KWADWO K ANSONG PHARM.D.,BCPS,BCGP,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11131 FLANKER WAY
RICHMOND TX
77407-1935
US

IV. Provider business mailing address

11131 FLANKER WAY
RICHMOND TX
77407-1935
US

V. Phone/Fax

Practice location:
  • Phone: 956-525-9461
  • Fax:
Mailing address:
  • Phone: 956-525-9461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number2867
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number45500
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number3150895
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: