Provider Demographics
NPI:1578253316
Name:ADDAE BOADU, DENNIS (PHARMD,RPH)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:ADDAE BOADU
Suffix:
Gender:M
Credentials:PHARMD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6234
Mailing Address - Country:US
Mailing Address - Phone:540-548-2144
Mailing Address - Fax:
Practice Address - Street 1:6010 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6234
Practice Address - Country:US
Practice Address - Phone:540-548-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202220895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist