MEDICARE: SANKOFA PHARMACY INC

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	3336C0003X	Community/Retail Pharmacy	PP481988	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2125563	OTHER		PK

General Provider Information

NPI Number	:	1275854085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANKOFA PHARMACY INC

Provider Business Mailing Address
First Line	:	7223 RISING SUN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3926
Country	:	US
Telephone Number	:	215-268-3426
Fax Number	:	215-904-5973

Provider Business Practice Location Address
First Line	:	7223 RISING SUN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3926
Country	:	US
Telephone Number	:	215-268-3426
Fax Number	:	215-904-5973

Authorized Official
Title or Position	:	OWNER/PIC
Name	:	KOFI GBOMITA
Credential	:
Telephone Number	:	267-664-2388

Provider Enumeration Date	:	06/15/2010
Last Update Date	:	04/01/2016

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Directions to “SANKOFA PHARMACY INC ” Practice Location

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