MEDICARE: MR. KENNETH ROBERT KWAPISZEWSKI R.PH.

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	5302411282	MI

General Provider Information

NPI Number	:	1427372465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH ROBERT KWAPISZEWSKI R.PH.

Provider Business Mailing Address
First Line	:	1110 WHITE BIRCH TRL
Second Line	:
City	:	CHARLOTTE
State	:	MI
Zip	:	48813-7823
Country	:	US
Telephone Number	:	231-750-2429
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 W M 20
Second Line	:
City	:	NEW ERA
State	:	MI
Zip	:	49446-8173
Country	:	US
Telephone Number	:	231-750-2429
Fax Number	:

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

Provider Enumeration Date	:	03/19/2010
Last Update Date	:	03/19/2010

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