Provider Demographics
NPI:1184229924
Name:KALU, SAMPSON A (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SAMPSON
Middle Name:A
Last Name:KALU
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:SAMPSON
Other - Middle Name:A
Other - Last Name:KALU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:1271 GRAY HWY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-1919
Mailing Address - Country:US
Mailing Address - Phone:478-743-6979
Mailing Address - Fax:478-742-9572
Practice Address - Street 1:1271 GRAY HWY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-1919
Practice Address - Country:US
Practice Address - Phone:478-743-6979
Practice Address - Fax:478-742-9572
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist