Active NPI
Asiedu Boateng
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Beaver Dam, WI
National Provider Identifier
1730787227
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 17409-40
- Practice address
- 120 Frances LN
Beaver Dam, WI 53916-1165 - Phone
- (920) 885-5808
- Fax
- (920) 885-5976
- NPI assigned
- Oct 15, 2020
- Last updated
- Oct 15, 2020
- 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 Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 17409-40 | WI | Primary |
Addresses
Primary practice location
120 Frances LN
Beaver Dam, WI 53916-1165
Mailing address
951 Okeeffe Ave Apt 66
Sun Prairie, WI 53590-4129
Phone (608) 547-8385
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | aboaten.s01012.us@wal-mart.com | Health Information Exchange (HIE) |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17409-40 | WI | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602720000000",
"number": "1730787227",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "951 OKEEFFE AVE APT 66",
"city": "SUN PRAIRIE",
"state": "WI",
"postal_code": "535904129",
"telephone_number": "608-547-8385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 FRANCES LN",
"city": "BEAVER DAM",
"state": "WI",
"postal_code": "539161165",
"telephone_number": "920-885-5808",
"fax_number": "920-885-5976"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOATENG",
"first_name": "ASIEDU",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-15",
"last_updated": "2020-10-15",
"certification_date": "2020-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "WI",
"license": "17409-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "aboaten.s01012.us@wal-mart.com",
"affiliation": "N",
"endpointDescription": "secured work email",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "walmart health and wellness",
"address_1": "120 Frances Ln",
"city": "Beaver Dam",
"state": "WI",
"country_code": "US",
"postal_code": "539161165",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Beaver Dam, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.