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NPI Code Detail

MEDICARE: DR. KWANSAH NDEMO PHARMD

MEDICARE: DR. KWANSAH NDEMO 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
1183500000XPharmacist048062TX

General Provider Information

NPI Number : 1417284464
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KWANSAH NDEMO PHARMD
Provider Business Mailing Address
First Line : 6205 WESTCREEK DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76133-4319
Country : US
Telephone Number : 817-263-0962
Fax Number : 817-263-0697
Provider Business Practice Location Address
First Line : 6205 WESTCREEK DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76133-4319
Country : US
Telephone Number : 817-263-0962
Fax Number : 817-263-0697
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2009
Last Update Date : 11/12/2009

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