Healthcare Provider Details

I. General information

NPI: 1164685814
Provider Name (Legal Business Name): MS. KATHRYN ELIZABETH VANWINKLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 GULL RD
KALAMAZOO MI
49048-1021
US

IV. Provider business mailing address

9263 ARROWHEAD DR W
SCOTTS MI
49088-9727
US

V. Phone/Fax

Practice location:
  • Phone: 269-337-2933
  • Fax:
Mailing address:
  • Phone: 269-598-3116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302038093
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: