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General NPI Number Information
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NPI Number | 1730787227
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Entity Type | Individual
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Provider Name | DR. ASIEDU BOATENG
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Gender | Male
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 120 FRANCES LN
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City | BEAVER DAM
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State | WI
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Zip | 53916-1165
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Country | US
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Telephone | 920-885-5808
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Fax | 920-885-5976
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Provider Business Mailing Address
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Address Line | 951 OKEEFFE AVE APT 66
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City | SUN PRAIRIE
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State | WI
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Zip | 53590-4129
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Country | US
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Telephone | 608-547-8385
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 17409-40
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License Number State | WI
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