Provider Demographics
NPI:1689021495
Name:YEBOAH, KWAKU ANINAGYEI
Entity type:Individual
Prefix:DR
First Name:KWAKU
Middle Name:ANINAGYEI
Last Name:YEBOAH
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 1:3050 BAY RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2415
Mailing Address - Country:US
Mailing Address - Phone:989-792-9606
Mailing Address - Fax:
Practice Address - Street 1:3050 BAY RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2415
Practice Address - Country:US
Practice Address - Phone:989-792-9606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-21
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302043926183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302043926OtherMICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS