Healthcare Provider Details

I. General information

NPI: 1558991414
Provider Name (Legal Business Name): VICTORIA KUHAGEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 BROWN RD
AUBURN HILLS MI
48326-1307
US

IV. Provider business mailing address

4901 HAGGERTY RD
WEST BLOOMFIELD MI
48323-3903
US

V. Phone/Fax

Practice location:
  • Phone: 248-393-8114
  • Fax:
Mailing address:
  • Phone: 248-283-9082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302041142
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: