MEDICARE: DR. DADDY NIMOH BOATENG 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	PS46534	FL

General Provider Information

NPI Number	:	1508135724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DADDY NIMOH BOATENG PHARMD

Provider Business Mailing Address
First Line	:	20024 DATE PALM WAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3718
Country	:	US
Telephone Number	:	502-319-3419
Fax Number	:

Provider Business Practice Location Address
First Line	:	12878 US HIGHWAY 301
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-5801
Country	:	US
Telephone Number	:	352-437-5985
Fax Number	:

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

Provider Enumeration Date	:	12/16/2011
Last Update Date	:	03/23/2017

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