Healthcare Provider Details

I. General information

NPI: 1831411644
Provider Name (Legal Business Name): H MICHELLE KUZMITS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2010
Last Update Date: 02/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 E 3RD ST
BLOOMINGTON IN
47401-5427
US

IV. Provider business mailing address

9982 S SAINT ANDREWS LN
BLOOMINGTON IN
47401-8146
US

V. Phone/Fax

Practice location:
  • Phone: 812-336-8426
  • Fax: 812-336-4381
Mailing address:
  • Phone: 812-824-3982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26018239A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: