Healthcare Provider Details

I. General information

NPI: 1881978484
Provider Name (Legal Business Name): KATHERINE ANNE ANTHES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2011
Last Update Date: 10/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6425 28TH ST SE
GRAND RAPIDS MI
49546-6917
US

IV. Provider business mailing address

6425 28TH ST SE
GRAND RAPIDS MI
49546-6917
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-0340
  • Fax: 616-949-0903
Mailing address:
  • Phone: 616-949-0340
  • Fax: 616-949-0903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302032418
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: