Provider Demographics
NPI:1043857576
Name:KWAKPOVWE, TOBORE A
Entity type:Individual
Prefix:
First Name:TOBORE
Middle Name:A
Last Name:KWAKPOVWE
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 1:615 MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-3624
Mailing Address - Country:US
Mailing Address - Phone:603-444-4460
Mailing Address - Fax:
Practice Address - Street 1:615 MEADOW ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-3624
Practice Address - Country:US
Practice Address - Phone:603-444-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPHCY-00911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist