Individual
JOSEPH A MITIDIERI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
6020 KALAMAZOO AVE SE, KENTWOOD, MI 49508-7018
(616) 698-9165
Mailing address
5464 DISCOVERY DR SE, KENTWOOD, MI 49508-6650
(616) 292-2216
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302028142
MI
Other
Enumeration date
11/02/2011
Last updated
11/02/2011
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