Healthcare Provider Details

I. General information

NPI: 1437141603
Provider Name (Legal Business Name): MARILYN SUE KAMP PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WEISS ST (TRAVERSE CITY VA OUTPATIENT CLINIC)
SAGINAW MI
48602-5251
US

IV. Provider business mailing address

9917 CRESCENT SHORES RD
TRAVERSE CITY MI
49684-8080
US

V. Phone/Fax

Practice location:
  • Phone: 231-932-9720
  • Fax:
Mailing address:
  • Phone: 231-620-1297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number530241140
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: