Active NPI
Kwabena Boateng, PHARM.D.
- Pharmacist
- Fernandina Beach, FL
National Provider Identifier
1669678652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS41775
- Practice address
- 1525 Sadler Rd
Fernandina Beach, FL 32034-4467 - Phone
- (904) 261-2663
- Fax
- (904) 261-3796
- NPI assigned
- Jun 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS41775 | FL | Primary |
Addresses
Primary practice location
1525 Sadler Rd
Fernandina Beach, FL 32034-4467
Mailing address
12513 Highview Dr
Jacksonville, FL 32225-5726
Phone (904) 641-9825
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS41775 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669678652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12513 HIGHVIEW DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322255726",
"telephone_number": "904-641-9825",
"fax_number": "904-261-3796"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1525 SADLER RD",
"city": "FERNANDINA BEACH",
"state": "FL",
"postal_code": "320344467",
"telephone_number": "904-261-2663",
"fax_number": "904-261-3796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOATENG",
"first_name": "KWABENA",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS41775",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fernandina Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.