Provider Demographics
NPI:1730500323
Name:HIWASSEE PHARMACY
Entity Type:Organization
Organization Name:HIWASSEE PHARMACY
Other - Org Name:CREDO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OKECHUKWU
Authorized Official - Middle Name:C
Authorized Official - Last Name:UNOGU
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:931-337-9041
Mailing Address - Street 1:752 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-2610
Mailing Address - Country:US
Mailing Address - Phone:931-337-9041
Mailing Address - Fax:
Practice Address - Street 1:752 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2610
Practice Address - Country:US
Practice Address - Phone:931-337-9041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-26
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy