Provider Demographics
NPI:1265294912
Name:OPPONG, EMMANUEL (PHARMD)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:OPPONG
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 1:10205 BALTIMORE AVE APT 72055
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-4218
Mailing Address - Country:US
Mailing Address - Phone:240-610-7337
Mailing Address - Fax:
Practice Address - Street 1:8319 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-2542
Practice Address - Country:US
Practice Address - Phone:301-220-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist