Healthcare Provider Details

I. General information

NPI: 1356942478
Provider Name (Legal Business Name): ATUOBI NANA YIADOM PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 09/11/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 W FOUNTAIN ST
ALBERT LEA MN
56007-2437
US

IV. Provider business mailing address

404 W FOUNTAIN ST
ALBERT LEA MN
56007-2437
US

V. Phone/Fax

Practice location:
  • Phone: 507-373-2384
  • Fax:
Mailing address:
  • Phone: 218-221-4383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number125022
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: