Provider Demographics
NPI:1902445752
Name:BOJANG, ABDOU (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ABDOU
Middle Name:
Last Name:BOJANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 WELCHIRE FALLS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228-1695
Mailing Address - Country:US
Mailing Address - Phone:502-454-4106
Mailing Address - Fax:502-454-6328
Practice Address - Street 1:4009 POPLAR LEVEL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1523
Practice Address - Country:US
Practice Address - Phone:502-454-4106
Practice Address - Fax:502-454-6328
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021631A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYNONEMedicaid