Individual
MISS IMABONG UDOFIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
15531 GRAND RIVER AVE, DETROIT, MI 48227-2222
(313) 272-0202
(313) 272-9892
Mailing address
19180 W 11 MILE RD, LATHRUP VILLAGE, MI 48076-3207
(248) 569-3036
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302032030
MI
Other
Enumeration date
05/24/2007
Last updated
07/08/2007
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