Healthcare Provider Details

I. General information

NPI: 1336224880
Provider Name (Legal Business Name): KACI ODA CHAMBERLIN R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KACI LYNN ODA-MORSE

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S CLINTON ST
GRAND LEDGE MI
48837
US

IV. Provider business mailing address

1166 RUSSELL LEA DR
CHARLOTTE MI
48813-8785
US

V. Phone/Fax

Practice location:
  • Phone: 517-627-1670
  • Fax: 517-627-0068
Mailing address:
  • Phone: 517-541-0305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302032417
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: