Healthcare Provider Details

I. General information

NPI: 1730478553
Provider Name (Legal Business Name): NATALIE RAE SISSON PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COVERED VILLAGE MALL
BELDING MI
48809
US

IV. Provider business mailing address

12360 MCKINLEY RD
RODNEY MI
49342-9701
US

V. Phone/Fax

Practice location:
  • Phone: 616-794-2200
  • Fax:
Mailing address:
  • Phone: 231-250-3241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302036183
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: