MEDICARE: MRS. BRITTANY KINNEY PHARMD

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	183500000X	Pharmacist	5302041892	MI

General Provider Information

NPI Number	:	1134644461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRITTANY KINNEY PHARMD

Provider Business Mailing Address
First Line	:	3590 SUNRISE LN NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-3658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1231 E BELTLINE AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-4501
Country	:	US
Telephone Number	:	616-942-0954
Fax Number	:

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

Provider Enumeration Date	:	08/08/2017
Last Update Date	:	11/16/2021

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