Healthcare Provider Details

I. General information

NPI: 1073590378
Provider Name (Legal Business Name): SAMUEL K NKANSAH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14111 VAN NESS AVE VAN PARK PHARMACY
GARDENA CA
90249-2944
US

IV. Provider business mailing address

14111 VAN NESS AVE VAN PARK PHARMACY
GARDENA CA
90249-2944
US

V. Phone/Fax

Practice location:
  • Phone: 310-323-6260
  • Fax: 310-323-6267
Mailing address:
  • Phone: 310-323-6260
  • Fax: 310-323-6267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 36110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: