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General NPI Number Information
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NPI Number | 1154094456
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Entity Type | Individual
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Provider Name | CALLISTUS UMELOGU
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Gender | Male
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Dates
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Enumeration Date | 08/01/2021
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Last Update Date | 08/01/2021
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Provider Practice Location Address
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Address Line | 4350 DIXIE HWY
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City | WATERFORD
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State | MI
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Zip | 48329-3506
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Country | US
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Telephone | 248-674-0466
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Fax |
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Provider Business Mailing Address
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Address Line | 47450 ELLERY LN
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City | CANTON
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State | MI
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Zip | 48187-0078
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Country | US
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Telephone | 734-272-8892
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 5351016697
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License Number State | MI
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