Healthcare Provider Details

I. General information

NPI: 1861900615
Provider Name (Legal Business Name): KATIE RENEE GUINOT PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 44TH ST SE
KENTWOOD MI
49512-3878
US

IV. Provider business mailing address

778 ELEANOR ST NE
GRAND RAPIDS MI
49505-4254
US

V. Phone/Fax

Practice location:
  • Phone: 616-455-5151
  • Fax:
Mailing address:
  • Phone: 810-623-5144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302412011
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: