Provider Demographics
NPI:1912280769
Name:ADADJO, AMA K
Entity Type:Individual
Prefix:
First Name:AMA
Middle Name:K
Last Name:ADADJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMA
Other - Middle Name:
Other - Last Name:AMPADU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:149 DEMING ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-1731
Mailing Address - Country:US
Mailing Address - Phone:860-644-1210
Mailing Address - Fax:860-644-1916
Practice Address - Street 1:149 DEMING ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1731
Practice Address - Country:US
Practice Address - Phone:860-644-1210
Practice Address - Fax:860-644-1916
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist