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General NPI Number Information
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NPI Number | 1558627323
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Entity Type | Organization
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Legal Business Name | QUEENSWAY ENT. INC.
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 691 COLLINS ST SUITE 1B
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City | JOLIET
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State | IL
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Zip | 60432-1856
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Country | US
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Telephone | 630-236-9502
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4863
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City | NAPERVILLE
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State | IL
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Zip | 60567-4863
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. RICHMOND NIMAKO-BOATENG
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Credential | PHARM.D
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Telephone | 630-236-9502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State | IL
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