=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578979977
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADELAIDE ANTWI BOATENG-OKYERE PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2014
-----------------------------------------------------
Last Update Date | 07/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 INDUSTRIAL AVE
-----------------------------------------------------
City | CHELMSFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01824-3610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-250-1018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 VILLAGE ROCK LN UNIT 7
-----------------------------------------------------
City | NATICK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01760-5719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-262-7547
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH235179
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------