Provider Demographics
NPI:1487209516
Name:KILTS, KATHRYN ANN (PHARMD RPH)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ANN
Last Name:KILTS
Suffix:
Gender:F
Credentials:PHARMD RPH
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:PILCZUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD RPH
Mailing Address - Street 1:1230 10 MILE RD NW
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-9381
Mailing Address - Country:US
Mailing Address - Phone:616-227-0785
Mailing Address - Fax:
Practice Address - Street 1:100 MICHIGAN ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:866-989-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53024129971835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care