MEDICARE: MR. SEFIAMO NTUMI RPH

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
1	183500000X	Pharmacist	5302035738	MI

General Provider Information

NPI Number	:	1164721387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SEFIAMO NTUMI RPH

Provider Business Mailing Address
First Line	:	1701 M 139
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-6101
Country	:	US
Telephone Number	:	269-927-3101
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 M 139
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-6101
Country	:	US
Telephone Number	:	269-927-3101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2011
Last Update Date	:	03/28/2011

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