Healthcare Provider Details

I. General information

NPI: 1659235745
Provider Name (Legal Business Name): PRAISE ELOGE SETODJI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17030 N 49TH ST APT 1066
SCOTTSDALE AZ
85254-7658
US

IV. Provider business mailing address

17030 N 49TH ST APT 1066
SCOTTSDALE AZ
85254-7658
US

V. Phone/Fax

Practice location:
  • Phone: 402-690-2661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS027814
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: