Healthcare Provider Details

I. General information

NPI: 1487164927
Provider Name (Legal Business Name): KRISTI KAE BREGE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 S STATE ST
BIG RAPIDS MI
49307-2250
US

IV. Provider business mailing address

2845 CENTRAL PARK WAY NE APT 104
GRAND RAPIDS MI
49505-3480
US

V. Phone/Fax

Practice location:
  • Phone: 231-796-8659
  • Fax:
Mailing address:
  • Phone: 989-306-2462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302042015
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: