Provider Demographics
NPI:1780290544
Name:AGYEMANG SARKODIE, KWABENA
Entity type:Individual
Prefix:
First Name:KWABENA
Middle Name:
Last Name:AGYEMANG SARKODIE
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 1:11240 CHERRY HILL RD APT 101
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3844
Mailing Address - Country:US
Mailing Address - Phone:240-444-9894
Mailing Address - Fax:
Practice Address - Street 1:8201 OXON HILL RD
Practice Address - Street 2:
Practice Address - City:FT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4718
Practice Address - Country:US
Practice Address - Phone:310-839-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist