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General NPI Number Information
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NPI Number | 1497427991
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Entity Type | Individual
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Provider Name | LANORA KAY JEWETT
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Gender | Female
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Dates
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Enumeration Date | 10/02/2021
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Last Update Date | 10/02/2021
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Provider Practice Location Address
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Address Line | 4854 W US HIGHWAY 10
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City | LUDINGTON
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State | MI
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Zip | 49431-8703
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Country | US
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Telephone | 231-845-5873
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Fax |
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Provider Business Mailing Address
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Address Line | 3585 JEFFERSON RD
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City | PENTWATER
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State | MI
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Zip | 49449-9734
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Country | US
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Telephone | 231-742-2212
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 5303033959
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License Number State | MI
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