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General NPI Number Information
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NPI Number | 1386494888
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Entity Type | Individual
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Provider Name | ELLY KANTOLA
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Gender | Female
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Dates
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Enumeration Date | 03/26/2024
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 2201 S GETTY ST
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City | MUSKEGON
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State | MI
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Zip | 49444-1207
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Country | US
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Telephone | 231-737-1706
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Fax |
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Provider Business Mailing Address
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Address Line | 219 GOLD ST
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City | NEGAUNEE
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State | MI
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Zip | 49866-1821
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Country | US
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Telephone | 906-204-6904
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302415477
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License Number State | MI
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