Provider Demographics
NPI:1427372465
Name:KWAPISZEWSKI, KENNETH ROBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ROBERT
Last Name:KWAPISZEWSKI
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 1:1110 WHITE BIRCH TRL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-7823
Mailing Address - Country:US
Mailing Address - Phone:231-750-2429
Mailing Address - Fax:
Practice Address - Street 1:3001 W M 20
Practice Address - Street 2:
Practice Address - City:NEW ERA
Practice Address - State:MI
Practice Address - Zip Code:49446-8173
Practice Address - Country:US
Practice Address - Phone:231-750-2429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist