Healthcare Provider Details

I. General information

NPI: 1588402671
Provider Name (Legal Business Name): KEN KOCHANY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 COLUMBUS AVE
BAY CITY MI
48708-6831
US

IV. Provider business mailing address

1900 COLUMBUS AVE
BAY CITY MI
48708-6831
US

V. Phone/Fax

Practice location:
  • Phone: 989-894-3744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302029639
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: