Individual
KRIS DENZEL TUPAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
611 E DOUGLAS RD STE 407, MISHAWAKA, IN 46545-1468
(574) 335-6500
(574) 335-0771
Mailing address
707 E CEDAR ST, SUITE 200, SOUTH BEND, IN 46617-2057
(574) 335-8700
(574) 335-0741
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
STATE LICENSE
—
Enumeration date
06/15/2017
Last updated
06/15/2017
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