Individual
MR. KENNETH WAYNE VIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1125 WASHINGTON AVE, GRAND HAVEN, MI 49417-1625
(616) 842-4360
(616) 842-9590
Mailing address
13670 CLEVELAND AVE, NUNICA, MI 49448-9661
(616) 842-3754
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302411182
MI
Other
Enumeration date
10/18/2006
Last updated
07/08/2007
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