Provider Demographics
NPI:1073151031
Name:KINGSLEY PHARMACY AND COMPOUNDING CENTER
Entity Type:Organization
Organization Name:KINGSLEY PHARMACY AND COMPOUNDING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/RPH
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:REUTHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:231-263-7701
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:KINGSLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49649-0247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:114 S BROWNSON AVE
Practice Address - Street 2:
Practice Address - City:KINGSLEY
Practice Address - State:MI
Practice Address - Zip Code:49649-5103
Practice Address - Country:US
Practice Address - Phone:231-263-7701
Practice Address - Fax:231-263-7925
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINGSLEY PHARMACY AND COMPOUNDING CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy