Individual
KENZIE SHAY ELLICOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
226 W RIVER VALLEY DR, NEWAYGO, MI 49337-8972
(231) 652-6914
(231) 652-2650
Mailing address
162 E 56TH ST, NEWAYGO, MI 49337-9048
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302414374
MI
Other
Enumeration date
08/12/2022
Last updated
03/19/2025
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