Healthcare Provider Details

I. General information

NPI: 1366051914
Provider Name (Legal Business Name): SYLVESTER DWUMFOUR SARPONG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E NIZHONI BLVD
GALLUP NM
87301-5748
US

IV. Provider business mailing address

3420 SANOSTEE DR APT O107
GALLUP NM
87301-7303
US

V. Phone/Fax

Practice location:
  • Phone: 505-339-9200
  • Fax:
Mailing address:
  • Phone: 336-686-9091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03439991
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberRPH6374
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: