Healthcare Provider Details

I. General information

NPI: 1922647833
Provider Name (Legal Business Name): EMANGA EKINDE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2795 PILOT KNOB RD
EAGAN MN
55121-1176
US

IV. Provider business mailing address

8593 SAVANNA OAKS LN
WOODBURY MN
55125-9611
US

V. Phone/Fax

Practice location:
  • Phone: 651-846-9245
  • Fax:
Mailing address:
  • Phone: 651-600-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number124173
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: