Healthcare Provider Details

I. General information

NPI: 1396677332
Provider Name (Legal Business Name): ASSUMPTA EZENWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32895 SCHOENHERR RD
WARREN MI
48088-1460
US

IV. Provider business mailing address

32895 SCHOENHERR RD
WARREN MI
48088-1460
US

V. Phone/Fax

Practice location:
  • Phone: 734-353-8591
  • Fax: 734-353-8591
Mailing address:
  • Phone: 734-353-8591
  • Fax: 734-353-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5301013931
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: