Emmanuel Addo
Individual provider Active NPI Pharmacist · Mansfield, TX
NPI 1225468630 · NPPES record last updated Jun 12, 2026
Key facts
- NPI
- 1225468630
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 54207 (TX)
- Practice address
- 3300 E Broad St
Mansfield, TX 76063-5626 - Phone
- (817) 435-5418
- NPI assigned
- Nov 21, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54207 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kroger Texas LP | Past | Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients | |
| Kroger Texas L P | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 54207 | TX | Yes |
Addresses
Primary practice location
3300 E Broad St
Mansfield, TX 76063-5626
Mailing address
3300 E Broad St
Mansfield, TX 76063-5626
Phone (817) 435-5418
Other providers in Mansfield, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.