Provider Demographics
NPI:1356782148
Name:AMADI, KALU O (PHARMD,MSC,, BSC)
Entity type:Individual
Prefix:DR
First Name:KALU
Middle Name:O
Last Name:AMADI
Suffix:
Gender:M
Credentials:PHARMD,MSC,, BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 MCCARY ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-8149
Mailing Address - Country:US
Mailing Address - Phone:972-637-3721
Mailing Address - Fax:
Practice Address - Street 1:4202 S CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3213
Practice Address - Country:US
Practice Address - Phone:972-266-7909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist