Basic Information
| Provider Information | |||||||||
| NPI: | 1356782148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMADI | ||||||||
| FirstName: | KALU | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM.D.,M.SC,, B.SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1205 MCCARY ST | ||||||||
| Address2: | |||||||||
| City: | CEDAR HILL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751048149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726373721 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4202 S CARRIER PKWY | ||||||||
| Address2: | |||||||||
| City: | GRAND PRAIRIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750523213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722667909 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2013 | ||||||||
| LastUpdateDate: | 07/09/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 49507 | TX | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.