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NPI Code Detail

MEDICARE: MR. PHILIP ENEZAKA ITUAH B.PHARM

MEDICARE: MR. PHILIP ENEZAKA ITUAH B.PHARM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist5302035915MI

General Provider Information

NPI Number : 1093135006
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PHILIP ENEZAKA ITUAH B.PHARM
Provider Business Mailing Address
First Line : 4989 STATE ST
Second Line :
City : SAGINAW
State : MI
Zip : 48603-3892
Country : US
Telephone Number : 989-791-3088
Fax Number :
Provider Business Practice Location Address
First Line : 4989 STATE ST
Second Line :
City : SAGINAW
State : MI
Zip : 48603-3892
Country : US
Telephone Number : 989-791-3088
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2014
Last Update Date : 04/17/2014

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