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General NPI Number Information
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NPI Number | 1275854085
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Entity Type | Organization
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Legal Business Name | SANKOFA PHARMACY INC
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 04/01/2016
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Provider Practice Location Address
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Address Line | 7223 RISING SUN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19111-3926
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Country | US
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Telephone | 215-268-3426
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Fax | 215-904-5973
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Provider Business Mailing Address
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Address Line | 7223 RISING SUN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19111-3926
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Country | US
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Telephone | 215-268-3426
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Fax | 215-904-5973
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Authorized Official
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Title or Position | OWNER/PIC
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Name | KOFI GBOMITA
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Credential |
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Telephone | 267-664-2388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP481988
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License Number State | PA
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