Provider Demographics
NPI:1407224736
Name:SANKOFA PHARMACY
Entity Type:Organization
Organization Name:SANKOFA PHARMACY
Other - Org Name:EAST FALLS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-297-5427
Mailing Address - Street 1:3500 SUNNYSIDE AVE # 3508
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1448
Mailing Address - Country:US
Mailing Address - Phone:267-297-5427
Mailing Address - Fax:267-331-8883
Practice Address - Street 1:3500 SUNNYSIDE AVE # 3508
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1448
Practice Address - Country:US
Practice Address - Phone:267-297-5427
Practice Address - Fax:267-331-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4825613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024748590001Medicaid
2152801OtherPK