Healthcare Provider Details

I. General information

NPI: 1427983907
Provider Name (Legal Business Name): BROOKE KYLIE SHULTZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 E LAKE ST
TAWAS CITY MI
48763-9213
US

IV. Provider business mailing address

621 E LAKE ST
TAWAS CITY MI
48763-9213
US

V. Phone/Fax

Practice location:
  • Phone: 989-984-0924
  • Fax:
Mailing address:
  • Phone: 989-984-0924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5351017409
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: