Healthcare Provider Details

I. General information

NPI: 1376918284
Provider Name (Legal Business Name): CHRISTOPHER KOWALSKI PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5859 28TH ST SE
GRAND RAPIDS MI
49546-6905
US

IV. Provider business mailing address

5859 28TH ST SE
GRAND RAPIDS MI
49546-6905
US

V. Phone/Fax

Practice location:
  • Phone: 970-404-0576
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5032032355
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16677
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: