Provider Demographics
NPI:1578710497
Name:KALU, MBA UKOHA (RPH)
Entity Type:Individual
Prefix:
First Name:MBA
Middle Name:UKOHA
Last Name:KALU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6322 WINDY RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-6630
Mailing Address - Country:US
Mailing Address - Phone:404-625-3566
Mailing Address - Fax:404-297-4057
Practice Address - Street 1:6322 WINDY RIDGE WAY
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-6630
Practice Address - Country:US
Practice Address - Phone:404-625-3566
Practice Address - Fax:404-297-4057
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH016628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist