Provider Demographics
NPI:1689110124
Name:UKANDU, NGOZI (RPH)
Entity Type:Individual
Prefix:
First Name:NGOZI
Middle Name:
Last Name:UKANDU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 INDIAN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2239
Mailing Address - Country:US
Mailing Address - Phone:313-231-8433
Mailing Address - Fax:
Practice Address - Street 1:1817 INDIAN TRAIL RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-2239
Practice Address - Country:US
Practice Address - Phone:313-231-8433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-08
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist