Provider Demographics
NPI:1376438390
Name:MENSAH FORDJOUR, PHINEHAS
Entity type:Individual
Prefix:
First Name:PHINEHAS
Middle Name:
Last Name:MENSAH FORDJOUR
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 1:33 SOPHIA DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01607-1814
Mailing Address - Country:US
Mailing Address - Phone:774-331-9934
Mailing Address - Fax:
Practice Address - Street 1:1035 TRUMAN HWY
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02136-3326
Practice Address - Country:US
Practice Address - Phone:617-361-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH1001434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist