Individual
MR. KERRY BRISKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
5500 CLYDE PARK AVE SW, WYOMING, MI 49509-9525
(616) 530-7133
(616) 530-7165
Mailing address
5500 CLYDE PARK AVE SW, WYOMING, MI 49509-9525
(616) 530-7133
(616) 530-7165
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302026104
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5302026104
PHARMACY LICENSE NUMBER
MI
Enumeration date
12/23/2013
Last updated
12/23/2013
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