MEDICARE: KARI LYNN SECORD PHARMACY TECHNITION

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	183700000X	Pharmacy Technician	5303017765	MI

General Provider Information

NPI Number	:	1487354387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARI LYNN SECORD PHARMACY TECHNITION

Provider Business Mailing Address
First Line	:	9392 DODGE RD APT 1
Second Line	:
City	:	OTISVILLE
State	:	MI
Zip	:	48463-8429
Country	:	US
Telephone Number	:	707-338-0933
Fax Number	:

Provider Business Practice Location Address
First Line	:	4515 E MOUNT MORRIS RD
Second Line	:
City	:	MOUNT MORRIS
State	:	MI
Zip	:	48458-8737
Country	:	US
Telephone Number	:	810-640-2110
Fax Number	:	810-640-1560

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

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	03/08/2023

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