Provider Demographics
NPI:1164096525
Name:KACH, AMELIA L
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:L
Last Name:KACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 KNOB HILL DR APT 12
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3563
Mailing Address - Country:US
Mailing Address - Phone:517-582-3671
Mailing Address - Fax:
Practice Address - Street 1:3106 E SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4712
Practice Address - Country:US
Practice Address - Phone:517-337-1681
Practice Address - Fax:517-337-1616
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy