Provider Demographics
NPI:1073925780
Name:MENSAH, ANDREWS
Entity Type:Individual
Prefix:
First Name:ANDREWS
Middle Name:
Last Name:MENSAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 VALLEY EDGE DR UNIT 107
Mailing Address - Street 2:APT/SUITE
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7363
Mailing Address - Country:US
Mailing Address - Phone:704-712-2855
Mailing Address - Fax:
Practice Address - Street 1:110 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-4875
Practice Address - Country:US
Practice Address - Phone:252-824-8175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist