Provider Demographics
NPI:1700435674
Name:NKAN, EDIKAN (RPH)
Entity type:Individual
Prefix:
First Name:EDIKAN
Middle Name:
Last Name:NKAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 NW 17TH PL APT 120
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6953
Mailing Address - Country:US
Mailing Address - Phone:754-214-1646
Mailing Address - Fax:
Practice Address - Street 1:1800 N NOB HILL RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-6565
Practice Address - Country:US
Practice Address - Phone:954-916-9713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist