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General NPI Number Information
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NPI Number | 1942594270
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Entity Type | Individual
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Provider Name | MARK KNOWLTON PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2011
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Last Update Date | 06/03/2011
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Provider Practice Location Address
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Address Line | 334 CHICAGO DR T-0399
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City | JENISON
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State | MI
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Zip | 49428-9244
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Country | US
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Telephone | 616-457-2730
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Fax | 616-457-2730
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Provider Business Mailing Address
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Address Line | 334 CHICAGO DR T-0399
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City | JENISON
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State | MI
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Zip | 49428-9244
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Country | US
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Telephone | 616-457-2730
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Fax | 616-457-2730
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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 | 5302034016
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License Number State | MI
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