Healthcare Provider Details

I. General information

NPI: 1386217701
Provider Name (Legal Business Name): ALLISON ANN SYREWICZE CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 S STATE ST
BIG RAPIDS MI
49307-2298
US

IV. Provider business mailing address

618 MARION AVE
BIG RAPIDS MI
49307-1352
US

V. Phone/Fax

Practice location:
  • Phone: 231-796-8659
  • Fax: 231-796-3835
Mailing address:
  • Phone: 231-250-6340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303008701
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: