MEDICARE: DR. KIRSTEN FREITEL 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	5302039533	MI

General Provider Information

NPI Number	:	1609206754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRSTEN FREITEL PHARMD

Provider Business Mailing Address
First Line	:	8455 HAGGERTY RD
Second Line	:
City	:	VAN BUREN TWP
State	:	MI
Zip	:	48111-1607
Country	:	US
Telephone Number	:	877-460-8303
Fax Number	:

Provider Business Practice Location Address
First Line	:	8455 HAGGERTY RD
Second Line	:
City	:	VAN BUREN TWP
State	:	MI
Zip	:	48111-1607
Country	:	US
Telephone Number	:	877-460-8303
Fax Number	:

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

Provider Enumeration Date	:	11/26/2013
Last Update Date	:	12/05/2023

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