Individual
KRISTY ANN WITHROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1462 E GRAND RIVER AVE, PORTLAND, MI 48875-1632
(517) 930-1864
Mailing address
1462 E GRAND RIVER AVE, PORTLAND, MI 48875-1632
(517) 930-1864
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302031351
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5302031351
PHARMACIST LICENSE
MI
Enumeration date
01/24/2022
Last updated
01/24/2022
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