Provider Demographics
NPI:1245520709
Name:BOATENG, DOREEN AMANKWA
Entity type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:AMANKWA
Last Name:BOATENG
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DOREEN
Other - Middle Name:BOATENG
Other - Last Name:BROBBEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:4908 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3406
Mailing Address - Country:US
Mailing Address - Phone:718-693-4138
Mailing Address - Fax:718-940-1691
Practice Address - Street 1:4908 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3406
Practice Address - Country:US
Practice Address - Phone:718-693-4138
Practice Address - Fax:718-940-1691
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI037254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist