Manzan G Koffi, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

PD16429 Issued in AR

Practice address

3908 N State Line Ave
Texarkana, AR 71854-1935

Phone

(870) 772-0236

NPI assigned

Feb 15, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Arkansas CVS Pharmacy L.L.C.

  • Pharmacy
  • Texarkana, AR
  • NPI 1659629152
  NPD (past)
• Arkansas CVS Pharmacy LLC

  • Pharmacy
  • North Little Rock, AR
  • NPI 1760951602
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1676419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677110400000",
    "number": "1154028520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6210 GIBSON LN APT 5306",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755031256",
            "telephone_number": "682-217-0275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3908 N STATE LINE AVE",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718541935",
            "telephone_number": "870-772-0236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOFFI",
        "first_name": "MANZAN",
        "middle_name": "G",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-15",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AR",
            "license": "PD16429",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "N/A",
            "identifier": "0000000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Kennington, LCSW
• Kevin B Seddens Ddspllc
• Bianca R Kisselburg, LPC
• Nancy Francine Knowles
• Eric Koenig, M.A., CCC-A
• Larry Lee Kretz, RN
• Heather Kroll
• Jennifer Kathleen Lacefield, BA
• Lashonda Lafayette
• Lindy A Landreaux, LCSW

• All providers in Texarkana, AR
• Pharmacist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.