Provider Demographics
NPI:1053713412
Name:DONKOR, KOFI N (PHARMD, BCOP, MHA)
Entity type:Individual
Prefix:DR
First Name:KOFI
Middle Name:N
Last Name:DONKOR
Suffix:
Gender:M
Credentials:PHARMD, BCOP, MHA
Other - Prefix:DR
Other - First Name:KOFI
Other - Middle Name:NTI POKU
Other - Last Name:DONKOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD, BCOP, MHA
Mailing Address - Street 1:34098 LILY RD
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2291
Mailing Address - Country:US
Mailing Address - Phone:310-339-3275
Mailing Address - Fax:
Practice Address - Street 1:34098 LILY RD
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2291
Practice Address - Country:US
Practice Address - Phone:310-339-3275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58467183500000X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology
No183500000XPharmacy Service ProvidersPharmacist