Healthcare Provider Details

I. General information

NPI: 1427372465
Provider Name (Legal Business Name): KENNETH ROBERT KWAPISZEWSKI R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 W M 20
NEW ERA MI
49446-8173
US

IV. Provider business mailing address

1110 WHITE BIRCH TRL
CHARLOTTE MI
48813-7823
US

V. Phone/Fax

Practice location:
  • Phone: 231-750-2429
  • Fax:
Mailing address:
  • Phone: 231-750-2429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302411282
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: