Healthcare Provider Details

I. General information

NPI: 1285238949
Provider Name (Legal Business Name): BRIGHT KOMLA EDEM KOFI-NYARKO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 NE 26TH ST
WILTON MANORS FL
33305-1245
US

IV. Provider business mailing address

3011 W SIGNATURE DR APT 205
DAVIE FL
33314-6455
US

V. Phone/Fax

Practice location:
  • Phone: 954-566-7474
  • Fax:
Mailing address:
  • Phone: 240-468-3622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS48754
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: