Provider Demographics
NPI:1003525361
Name:KRUPP, WILLIAM C (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:C
Last Name:KRUPP
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6975 PITTSFORD ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2727
Mailing Address - Country:US
Mailing Address - Phone:734-756-6459
Mailing Address - Fax:
Practice Address - Street 1:3717 FENTON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1554
Practice Address - Country:US
Practice Address - Phone:810-232-5118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist