=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396843975
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES J KUNZ RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 324 SUPERIOR AVENUE
-----------------------------------------------------
City | CRYSTAL FALLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49920-1427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-875-6781
-----------------------------------------------------
Fax | 906-875-6781
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 324 SUPERIOR AVENUE
-----------------------------------------------------
City | CRYSTAL FALLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49920-1427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-875-6781
-----------------------------------------------------
Fax | 906-875-6781
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5301004473
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------