Healthcare Provider Details

I. General information

NPI: 1033492509
Provider Name (Legal Business Name): NKEMDILIM CAROLINE OKOYE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 WASHTENAW RD
YPSILANTI MI
48197-1744
US

IV. Provider business mailing address

2170 WASHTENAW RD
YPSILANTI MI
48197-1744
US

V. Phone/Fax

Practice location:
  • Phone: 734-485-3899
  • Fax:
Mailing address:
  • Phone: 734-485-3899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302038072
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: