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Organization
KINGSWAY ENT. INC
Active
Organization
KINGSWAY ENT. INC
Active
Other names
KINGSWAY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHMOND G NIMAKO-BOATENG PHARM.D, RPH. (PRESIDENT)
(630) 236-9502
Entity
Organization
Contact information
Practice address
1677 MONTGOMERY RD, SUITE 110-112, AURORA, IL 60504-8802
(630) 236-9502
(630) 236-9512
Mailing address
1677 MONTGOMERY RD, SUITE 110-112, AURORA, IL 60504-8802
(630) 236-9502
(630) 236-9512
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
054015027
IL
3336C0003X
Community/Retail Pharmacy
Primary
054015027
IL
3336C0004X
Compounding Pharmacy
054015027
IL
335E00000X
Prosthetic/Orthotic Supplier
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1476426
NCPDP
—
Enumeration date
12/17/2006
Last updated
09/09/2010
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