Healthcare Provider Details

I. General information

NPI: 1164906020
Provider Name (Legal Business Name): KYLE JOSEPH FICHT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 06/07/2020
Certification Date: 06/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 WALDRON WAY
BIG RAPIDS MI
49307-8890
US

IV. Provider business mailing address

15400 WALDRON WAY
BIG RAPIDS MI
49307-8890
US

V. Phone/Fax

Practice location:
  • Phone: 231-527-0210
  • Fax:
Mailing address:
  • Phone: 231-527-0210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302047074
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: