Provider Demographics
NPI:1073715397
Name:NESBITT, KENYETTA NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KENYETTA
Middle Name:NICOLE
Last Name:NESBITT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-5232
Mailing Address - Country:US
Mailing Address - Phone:810-232-5328
Mailing Address - Fax:
Practice Address - Street 1:259 MACK AVE
Practice Address - Street 2:EACPHS SUITE 2190
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2427
Practice Address - Country:US
Practice Address - Phone:313-993-7465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020332791835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy