Provider Demographics
NPI:1336224880
Name:CHAMBERLIN, KACI ODA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KACI
Middle Name:ODA
Last Name:CHAMBERLIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:KACI
Other - Middle Name:LYNN
Other - Last Name:ODA-MORSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1166 RUSSELL LEA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-8785
Mailing Address - Country:US
Mailing Address - Phone:517-541-0305
Mailing Address - Fax:
Practice Address - Street 1:508 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837
Practice Address - Country:US
Practice Address - Phone:517-627-1670
Practice Address - Fax:517-627-0068
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist