Healthcare Provider Details

I. General information

NPI: 1063060234
Provider Name (Legal Business Name): MARIAH KUNTZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 S CEDAR ST
IMLAY CITY MI
48444-1344
US

IV. Provider business mailing address

1821 S CEDAR ST
IMLAY CITY MI
48444-1344
US

V. Phone/Fax

Practice location:
  • Phone: 810-721-3262
  • Fax:
Mailing address:
  • Phone: 586-707-0067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302411517
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: