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NPI Code Detail

MEDICARE: KYESHA ARIANE LIPSCOMB PHARM. D.

MEDICARE: KYESHA ARIANE LIPSCOMB 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
1183500000XPharmacist5302044854MI

General Provider Information

NPI Number : 1376094771
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYESHA ARIANE LIPSCOMB PHARM. D.
Provider Business Mailing Address
First Line : 1260 HILLTOP RD
Second Line :
City : SAINT JOSEPH
State : MI
Zip : 49085-2839
Country : US
Telephone Number : 269-983-0315
Fax Number :
Provider Business Practice Location Address
First Line : 1710 W JOHN BEERS RD
Second Line :
City : STEVENSVILLE
State : MI
Zip : 49127-9409
Country : US
Telephone Number : 269-429-1153
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2016
Last Update Date : 06/17/2020

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