Individual
KYLE CASEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
18025 FORT ST, SUITE C, RIVERVIEW, MI 48193-7432
(734) 225-7171
Mailing address
18025 FORT ST., SUITE C, RIVERVIEW, MI 48193
(734) 225-7171
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5306004711
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5306004711
STATE OF MICHIGAN- DME LICENSE
MI
Enumeration date
11/04/2016
Last updated
11/04/2016
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