Healthcare Provider Details

I. General information

NPI: 1568931236
Provider Name (Legal Business Name): EMMANUEL O. ADDO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2018
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 ALASKA HWY
DELTA JUNCTION AK
99737
US

IV. Provider business mailing address

PO BOX 5
GLENNALLEN AK
99588-0589
US

V. Phone/Fax

Practice location:
  • Phone: 907-895-6244
  • Fax:
Mailing address:
  • Phone: 907-895-6244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26199
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number246881
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: