Provider Demographics
NPI:1043533235
Name:KAYE, KRISTOPHER AVERY (RPH)
Entity Type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:AVERY
Last Name:KAYE
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 1:3737 PICKEREL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9326
Mailing Address - Country:US
Mailing Address - Phone:231-487-0778
Mailing Address - Fax:
Practice Address - Street 1:1401 SPRING ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2884
Practice Address - Country:US
Practice Address - Phone:231-347-7281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302301094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302031094OtherBOARD OF PHARMACY PRACTICE LICENSE