Provider Demographics
NPI:1063921690
Name:NKWAYEP, JEAN-BERTRAND SAHYON (RPH)
Entity type:Individual
Prefix:
First Name:JEAN-BERTRAND
Middle Name:SAHYON
Last Name:NKWAYEP
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 1:4805 ROSCOMMON DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-2736
Mailing Address - Country:US
Mailing Address - Phone:872-214-7204
Mailing Address - Fax:
Practice Address - Street 1:2701 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3028
Practice Address - Country:US
Practice Address - Phone:517-272-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302045995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist