=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013928936
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAHARA MARKETING INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 08/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 370 S ORANGE AVE
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07103-1963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-353-0500
-----------------------------------------------------
Fax | 973-353-0600
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 370 S ORANGE AVE
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07103-1963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KOFI YEBOAH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-353-0500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 28RS00650600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------