MEDICARE: VINCENT UMEJIEGO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	26030082A	IN

General Provider Information

NPI Number	:	1720859234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT UMEJIEGO

Provider Business Mailing Address
First Line	:	6724 RAMBLEWOOD CT APT B
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-1757
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6724 RAMBLEWOOD CT APT B
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-1757
Country	:	US
Telephone Number	:	313-653-9609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2024
Last Update Date	:	01/12/2024

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Directions to “ VINCENT UMEJIEGO ” Practice Location

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