MEDICARE: KWABENA A AGYEKUM PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	I053661-1	NY

General Provider Information

NPI Number	:	1134441876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KWABENA A AGYEKUM PHARMD

Provider Business Mailing Address
First Line	:	1849 SEDGWICK AVE APT 3D
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-5047
Country	:	US
Telephone Number	:	551-221-3628
Fax Number	:

Provider Business Practice Location Address
First Line	:	1849 SEDGWICK AVE APT 3D
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-5047
Country	:	US
Telephone Number	:	551-221-3628
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2010
Last Update Date	:	02/22/2010

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