Healthcare Provider Details

I. General information

NPI: 1780902791
Provider Name (Legal Business Name): JENNY MARIE KAWWAS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37399 6 MILE RD
LIVONIA MI
48152-2775
US

IV. Provider business mailing address

23976 WESTMONT DR
NOVI MI
48374-3658
US

V. Phone/Fax

Practice location:
  • Phone: 734-464-7960
  • Fax:
Mailing address:
  • Phone: 248-305-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302029133
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: