Healthcare Provider Details

I. General information

NPI: 1740916782
Provider Name (Legal Business Name): KAAINAAT BEELUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2022
Last Update Date: 07/30/2022
Certification Date: 07/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6660 W MAIN ST
KALAMAZOO MI
49009-3962
US

IV. Provider business mailing address

848 NIAGRA PRESERVATION CIR APT 203
KALAMAZOO MI
49006-6136
US

V. Phone/Fax

Practice location:
  • Phone: 269-372-9100
  • Fax:
Mailing address:
  • Phone: 313-597-6723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5351017122
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: