Provider Demographics
NPI:1952670150
Name:MENSAH, PRINCE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:PRINCE
Middle Name:
Last Name:MENSAH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 W AVENUE J
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2745
Mailing Address - Country:US
Mailing Address - Phone:661-723-0363
Mailing Address - Fax:661-723-0547
Practice Address - Street 1:1834 W AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2745
Practice Address - Country:US
Practice Address - Phone:661-723-0363
Practice Address - Fax:661-723-0547
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist