Provider Demographics
NPI:1487934626
Name:AGYEMANG, JOHN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:AGYEMANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 405
Mailing Address - Street 2:BOX 7688
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09034
Mailing Address - Country:US
Mailing Address - Phone:49637-186-7220
Mailing Address - Fax:49637-185-7220
Practice Address - Street 1:LANDSTUHL REGIONAL MEDICAL CENTER
Practice Address - Street 2:CMR 405 BOX 7688
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09034-7688
Practice Address - Country:US
Practice Address - Phone:49637-185-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444864183500000X
NJ28RI03165100183500000X
NC18567183500000X
CTPCT 99251835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy