=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467026203
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAKYI KOBINA SARSAH PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2021
-----------------------------------------------------
Last Update Date | 05/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11200 MARTIN LUTHER KING BLVD E STE 103
-----------------------------------------------------
City | SEFFNER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33584-8351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-900-7778
-----------------------------------------------------
Fax | 813-235-4726
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11200 MARTIN LUTHER KING BLVD E STE 103
-----------------------------------------------------
City | SEFFNER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33584-8351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-900-7778
-----------------------------------------------------
Fax | 813-235-4726
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS50949
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------