Provider Demographics
NPI:1710256490
Name:UMEZURIKE, KINGSLEY NWABUKO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KINGSLEY
Middle Name:NWABUKO
Last Name:UMEZURIKE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4946 BROWN LEAF DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-8918
Mailing Address - Country:US
Mailing Address - Phone:678-457-6557
Mailing Address - Fax:
Practice Address - Street 1:4946 BROWN LEAF DR
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-8918
Practice Address - Country:US
Practice Address - Phone:678-457-6557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH02168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist