Healthcare Provider Details

I. General information

NPI: 1720731516
Provider Name (Legal Business Name): COURAGE DODZI DZIEKPOR PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 MCGREGOR ST STE 4
MANCHESTER NH
03102-3746
US

IV. Provider business mailing address

17 BANGOR ST
NASHUA NH
03063-1537
US

V. Phone/Fax

Practice location:
  • Phone: 603-627-3822
  • Fax:
Mailing address:
  • Phone: 617-669-7753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPHCY-01287
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: