MEDICARE: DR. KENYETTA NICOLE NESBITT PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	5302033279	MI

General Provider Information

NPI Number	:	1073715397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENYETTA NICOLE NESBITT PHARM.D.

Provider Business Mailing Address
First Line	:	1301 COLUMBIA DR
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48503-5232
Country	:	US
Telephone Number	:	810-232-5328
Fax Number	:

Provider Business Practice Location Address
First Line	:	259 MACK AVE
Second Line	:	EACPHS SUITE 2190
City	:	DETROIT
State	:	MI
Zip	:	48201-2427
Country	:	US
Telephone Number	:	313-993-7465
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	07/08/2007

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