MEDICARE: SAMUEL K NKANSAH RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH 36110	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0592318	OTHER	CA	NCPDP

General Provider Information

NPI Number	:	1073590378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL K NKANSAH RPH

Provider Business Mailing Address
First Line	:	14111 VAN NESS AVE
Second Line	:	VAN PARK PHARMACY
City	:	GARDENA
State	:	CA
Zip	:	90249-2944
Country	:	US
Telephone Number	:	310-323-6260
Fax Number	:	310-323-6267

Provider Business Practice Location Address
First Line	:	14111 VAN NESS AVE
Second Line	:	VAN PARK PHARMACY
City	:	GARDENA
State	:	CA
Zip	:	90249-2944
Country	:	US
Telephone Number	:	310-323-6260
Fax Number	:	310-323-6267

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	03/29/2026

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