Provider Demographics
NPI:1043334022
Name:KRAVETZKER, ARTHUR HOWARD
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:HOWARD
Last Name:KRAVETZKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5482 N PICCADILLY CIR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1439
Mailing Address - Country:US
Mailing Address - Phone:248-661-5260
Mailing Address - Fax:
Practice Address - Street 1:3252 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326
Practice Address - Country:US
Practice Address - Phone:248-852-5977
Practice Address - Fax:248-852-0062
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist