Healthcare Provider Details

I. General information

NPI: 1447188271
Provider Name (Legal Business Name): KELLY LYNN WITTENBERG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CAMPUS DR
HANCOCK MI
49930-1452
US

IV. Provider business mailing address

500 CAMPUS DR
HANCOCK MI
49930-1452
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1919
  • Fax: 906-483-1911
Mailing address:
  • Phone: 906-483-1919
  • Fax: 906-483-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302028511
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: