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NPI Code Detail

MEDICARE: KIM ENGLE RPH

MEDICARE: KIM ENGLE RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist5302029098MI

General Provider Information

NPI Number : 1235416942
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIM ENGLE RPH
Provider Business Mailing Address
First Line : 6790 CASCADE RD SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546
Country : US
Telephone Number : 616-954-2408
Fax Number :
Provider Business Practice Location Address
First Line : 6790 CASCADE RD SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-6860
Country : US
Telephone Number : 616-954-2408
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2011
Last Update Date : 11/09/2011

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