Individual
KEVIN MICHAEL DERIDDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D
Contact information
Practice address
5859 28TH ST SE, GRAND RAPIDS, MI 49546-6905
(616) 949-9892
Mailing address
6233 BLAKELY DR NE, ROCKFORD, MI 49341-9611
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302038129
MI
Other
Enumeration date
08/08/2011
Last updated
09/17/2024
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