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General NPI Number Information
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NPI Number | 1073900122
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Entity Type | Individual
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Provider Name | YAW OBENG-BOAMPONG PHARMD
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Gender | Male
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Dates
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Enumeration Date | 04/15/2015
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Last Update Date | 04/15/2015
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Provider Practice Location Address
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Address Line | 1403 WISCONSIN AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20007-2828
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Country | US
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Telephone | 202-337-4848
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Fax | 202-337-9602
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Provider Business Mailing Address
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Address Line | 10501 MONTROSE AVE APT 103
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City | BETHESDA
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State | MD
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Zip | 20814-4141
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Country | US
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Telephone | 804-714-5669
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 22664
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License Number State | MD
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