Provider Demographics
NPI:1497226633
Name:KINZER, MICHAEL (DPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:KINZER
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3191 FOSTER CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-7105
Mailing Address - Country:US
Mailing Address - Phone:931-922-6274
Mailing Address - Fax:
Practice Address - Street 1:103 PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TN
Practice Address - Zip Code:38474-1625
Practice Address - Country:US
Practice Address - Phone:931-922-6274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist