Provider Demographics
NPI:1386217701
Name:SYREWICZE, ALLISON ANN (CPHT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ANN
Last Name:SYREWICZE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1352
Mailing Address - Country:US
Mailing Address - Phone:231-250-6340
Mailing Address - Fax:
Practice Address - Street 1:842 S STATE ST
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2298
Practice Address - Country:US
Practice Address - Phone:231-796-8659
Practice Address - Fax:231-796-3835
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303008701183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician