Provider Demographics
NPI:1376857052
Name:NNAH, PRINCE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PRINCE
Middle Name:
Last Name:NNAH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18350 HATTERAS ST
Mailing Address - Street 2:256
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1665
Mailing Address - Country:US
Mailing Address - Phone:818-990-9634
Mailing Address - Fax:
Practice Address - Street 1:13333A RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2508
Practice Address - Country:US
Practice Address - Phone:818-990-9634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR53521835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist