Provider Demographics
NPI:1548987878
Name:AMOKWAW, MAC E
Entity type:Individual
Prefix:
First Name:MAC
Middle Name:E
Last Name:AMOKWAW
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 1:5208 98TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-4493
Mailing Address - Country:US
Mailing Address - Phone:806-794-1024
Mailing Address - Fax:806-794-1057
Practice Address - Street 1:5208 98TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-4493
Practice Address - Country:US
Practice Address - Phone:806-794-1024
Practice Address - Fax:806-794-1057
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist