Provider Demographics
NPI:1215608872
Name:KALO, KADIJAH GRACE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KADIJAH
Middle Name:GRACE
Last Name:KALO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 HOLLY WAY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-2543
Mailing Address - Country:US
Mailing Address - Phone:517-648-5846
Mailing Address - Fax:
Practice Address - Street 1:13020 OLD U.S. 127
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820
Practice Address - Country:US
Practice Address - Phone:517-624-5028
Practice Address - Fax:517-624-5029
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist