Provider Demographics
NPI:1336610682
Name:KANKAM, EDMOND OSEI
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:OSEI
Last Name:KANKAM
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 1:746 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-1460
Mailing Address - Country:US
Mailing Address - Phone:862-218-4268
Mailing Address - Fax:
Practice Address - Street 1:416 U.S 9
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721
Practice Address - Country:US
Practice Address - Phone:732-269-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03985300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist