Healthcare Provider Details

I. General information

NPI: 1760848303
Provider Name (Legal Business Name): ALICE KARASIEWIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 01/12/2016
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

1811 MICHIGAN ST NE APT 7B
GRAND RAPIDS MI
49503-2187
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-9892
  • Fax:
Mailing address:
  • Phone: 616-776-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302028286
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: