Provider Demographics
NPI:1114104288
Name:MPAMIRA, GRACE MUTESI (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:MUTESI
Last Name:MPAMIRA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N EAST AVE
Mailing Address - Street 2:SUITE 107 - ONE JACKSON SQUARE
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1753
Mailing Address - Country:US
Mailing Address - Phone:517-788-4800
Mailing Address - Fax:517-841-1725
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:SUITE 107 - ONE JACKSON SQUARE
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-788-4800
Practice Address - Fax:517-841-1725
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist