Provider Demographics
NPI:1831532647
Name:GYAMFI SARPONG, IAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:
Last Name:GYAMFI SARPONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:IAN
Other - Middle Name:GYAMFI
Other - Last Name:SARPONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3401 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60624-4339
Mailing Address - Country:US
Mailing Address - Phone:773-542-1232
Mailing Address - Fax:
Practice Address - Street 1:3401 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-4339
Practice Address - Country:US
Practice Address - Phone:773-542-1232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049176170183700000X
IN45017363A183700000X
IL051-299428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician