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General NPI Number Information
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NPI Number | 1497024996
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Entity Type | Individual
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Provider Name | EVA MARIE KASBOHM PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/29/2011
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Last Update Date | 01/08/2016
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Provider Practice Location Address
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Address Line | 1964 FULLER AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-4861
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Country | US
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Telephone | 616-364-7071
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Fax |
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Provider Business Mailing Address
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Address Line | 1605 E KENTVIEW DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-4872
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Country | US
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Telephone | 415-832-0777
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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 | 5302042301
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License Number State | MI
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