Healthcare Provider Details

I. General information

NPI: 1841601200
Provider Name (Legal Business Name): OLIVER TAKUH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 S. WESTNEDGE
KALAMAZOO MI
49008
US

IV. Provider business mailing address

6108 APPLEGROVE LN
PORTAGE MI
49024-9017
US

V. Phone/Fax

Practice location:
  • Phone: 269-337-2110
  • Fax:
Mailing address:
  • Phone: 269-267-5277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302041103
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: