Provider Demographics
NPI:1073590378
Name:NKANSAH, SAMUEL K (RPH)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:K
Last Name:NKANSAH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14111 VAN NESS AVE
Mailing Address - Street 2:VAN PARK PHARMACY
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-2944
Mailing Address - Country:US
Mailing Address - Phone:310-323-6260
Mailing Address - Fax:310-323-6267
Practice Address - Street 1:14111 VAN NESS AVE
Practice Address - Street 2:VAN PARK PHARMACY
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-2944
Practice Address - Country:US
Practice Address - Phone:310-323-6260
Practice Address - Fax:310-323-6267
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 36110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0592318OtherNCPDP
CA0592318OtherNCPDP