Provider Demographics
NPI:1952907628
Name:KIBITWE, ONKEMETSE PHILLIP (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ONKEMETSE
Middle Name:PHILLIP
Last Name:KIBITWE
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 1:12907 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2751
Mailing Address - Country:US
Mailing Address - Phone:313-926-8918
Mailing Address - Fax:313-822-2019
Practice Address - Street 1:12907 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2751
Practice Address - Country:US
Practice Address - Phone:313-926-8918
Practice Address - Fax:313-822-2019
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist