Provider Demographics
NPI:1245766781
Name:VIRTANEN, KRYSIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRYSIA
Middle Name:
Last Name:VIRTANEN
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 1:60 NINO DR
Mailing Address - Street 2:
Mailing Address - City:SAULT STE MARIE
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:P6B 3V6
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1138 W 3 MILE RD
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-9132
Practice Address - Country:US
Practice Address - Phone:906-253-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist