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NPI Code Detail

MEDICARE: KWAME AGYEPONG

MEDICARE: KWAME AGYEPONG
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
1183500000XPharmacist65465CA

General Provider Information

NPI Number : 1619385093
Entity Type Code : Individual
Provider Name (Legal Business Name) : KWAME AGYEPONG
Provider Business Mailing Address
First Line : 3223 E HAMMER LN
Second Line :
City : STOCKTON
State : CA
Zip : 95212-2815
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3223 E HAMMER LN
Second Line :
City : STOCKTON
State : CA
Zip : 95212-2815
Country : US
Telephone Number : 209-473-8951
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2014
Last Update Date : 07/29/2014

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Directions to “ KWAME AGYEPONG ” Practice Location

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