Healthcare Provider Details

I. General information

NPI: 1750914701
Provider Name (Legal Business Name): RENEE KUZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2387 ORCHARD LAKE RD
SYLVAN LAKE MI
48320-1651
US

IV. Provider business mailing address

2387 ORCHARD LAKE RD
SYLVAN LAKE MI
48320-1651
US

V. Phone/Fax

Practice location:
  • Phone: 248-682-3666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5315113098
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: