Healthcare Provider Details

I. General information

NPI: 1114157872
Provider Name (Legal Business Name): ANNA GRACE D'AMICO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 MICHIGAN AVE E
BATTLE CREEK MI
49014-6292
US

IV. Provider business mailing address

890 MICHIGAN AVE E
BATTLE CREEK MI
49014-6292
US

V. Phone/Fax

Practice location:
  • Phone: 269-660-9509
  • Fax: 269-660-9074
Mailing address:
  • Phone: 269-660-9509
  • Fax: 269-660-9074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302035298
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: