Healthcare Provider Details

I. General information

NPI: 1831403617
Provider Name (Legal Business Name): EDDU OPARIE-ADDOH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1839
US

IV. Provider business mailing address

11926 W JEFFERSON ST
AVONDALE AZ
85323-5725
US

V. Phone/Fax

Practice location:
  • Phone: 602-220-5551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number120115
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: