Provider Demographics
NPI:1134538176
Name:WIREDU, KWASI
Entity type:Individual
Prefix:DR
First Name:KWASI
Middle Name:
Last Name:WIREDU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 ORANGEPARK DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-2200
Mailing Address - Country:US
Mailing Address - Phone:843-822-1456
Mailing Address - Fax:
Practice Address - Street 1:805 ENTERPRISE RD
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-7821
Practice Address - Country:US
Practice Address - Phone:843-841-2228
Practice Address - Fax:843-841-0294
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist