Active NPI
Imabong Udofia, RPH
- Pharmacist
- Detroit, MI
National Provider Identifier
1740491877
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302032030
- Practice address
- 15531 Grand River Ave
Detroit, MI 48227-2222 - Phone
- (313) 272-0202
- Fax
- (313) 272-9892
- NPI assigned
- May 24, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302032030 | MI | Primary |
Addresses
Primary practice location
15531 Grand River Ave
Detroit, MI 48227-2222
Mailing address
19180 W 11 Mile Rd
Lathrup Village, MI 48076-3207
Phone (248) 569-3036
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302032030 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rite Aid of Michigan Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Rite Aid Pharmacy 04700
- Community/Retail Pharmacy
- Detroit, MI
- NPI 1992814479
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740491877",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19180 W 11 MILE RD",
"city": "LATHRUP VILLAGE",
"state": "MI",
"postal_code": "480763207",
"telephone_number": "248-569-3036"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15531 GRAND RIVER AVE",
"city": "DETROIT",
"state": "MI",
"postal_code": "482272222",
"telephone_number": "313-272-0202",
"fax_number": "313-272-9892"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UDOFIA",
"first_name": "IMABONG",
"name_prefix": "Miss",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302032030",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.