Provider Demographics
NPI:1184965683
Name:ADUBOFOUR, MICHAEL OPPONG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:OPPONG
Last Name:ADUBOFOUR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8416 FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-2302
Mailing Address - Country:US
Mailing Address - Phone:215-247-3050
Mailing Address - Fax:
Practice Address - Street 1:8416 FORREST AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-2302
Practice Address - Country:US
Practice Address - Phone:215-247-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP446602OtherSTATE LICENSE