Provider Demographics
NPI:1235449711
Name:CHRONIS, KIM BERNARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:BERNARD
Last Name:CHRONIS
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 1:66011 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48095-2002
Mailing Address - Country:US
Mailing Address - Phone:586-752-6569
Mailing Address - Fax:586-752-4781
Practice Address - Street 1:66011 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48095-2002
Practice Address - Country:US
Practice Address - Phone:586-752-6569
Practice Address - Fax:586-752-4781
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301024664183500000X
FLPS25735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist