MEDICARE: MR. CHARLES ALLEN KINSEY

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
1	183500000X	Pharmacist	5302032102	MI

General Provider Information

NPI Number	:	1750986485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES ALLEN KINSEY

Provider Business Mailing Address
First Line	:	PO BOX 579
Second Line	:
City	:	STANDISH
State	:	MI
Zip	:	48658-0579
Country	:	US
Telephone Number	:	989-846-0411
Fax Number	:	989-846-0463

Provider Business Practice Location Address
First Line	:	533 S MAIN ST
Second Line	:
City	:	STANDISH
State	:	MI
Zip	:	48658-9531
Country	:	US
Telephone Number	:	989-846-0411
Fax Number	:	989-846-0463

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/01/2020

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Directions to “ MR. CHARLES ALLEN KINSEY ” Practice Location

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