MEDICARE: KEVIN KRAWCZAK

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	1835P1200X	Pharmacotherapy Pharmacist	5302026904	MI

General Provider Information

NPI Number	:	1710397385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN KRAWCZAK

Provider Business Mailing Address
First Line	:	595 N PINE RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-9190
Country	:	US
Telephone Number	:	989-891-1533
Fax Number	:	989-891-1565

Provider Business Practice Location Address
First Line	:	595 N PINE RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-9190
Country	:	US
Telephone Number	:	989-891-1533
Fax Number	:	989-891-1565

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

Provider Enumeration Date	:	05/05/2014
Last Update Date	:	05/05/2014

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