Provider Demographics
NPI:1952992182
Name:KYEREMEH ADDO, GLORIA ADWOA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA ADWOA
Middle Name:
Last Name:KYEREMEH ADDO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11270 CHATTERLY LOOP APT 302
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-7857
Mailing Address - Country:US
Mailing Address - Phone:978-798-8974
Mailing Address - Fax:
Practice Address - Street 1:1511 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4631
Practice Address - Country:US
Practice Address - Phone:540-899-6874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist