Individual
SHAWN LEE GRUCELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
902 N CEDAR ST, KALKASKA, MI 49646-8061
(231) 258-2081
(231) 258-5883
Mailing address
11652 PHEASANT DR SW, FIFE LAKE, MI 49633-9055
(609) 744-6425
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
5303028132
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5303028132
STATE CERTIFICATION NUMBER
MI
Enumeration date
08/04/2021
Last updated
08/04/2021
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