Provider Demographics
NPI:1679162804
Name:SORENSEN, DAVID K
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E STATE HIGHWAY M35
Mailing Address - Street 2:
Mailing Address - City:GWINN
Mailing Address - State:MI
Mailing Address - Zip Code:49841-9159
Mailing Address - Country:US
Mailing Address - Phone:906-346-3340
Mailing Address - Fax:
Practice Address - Street 1:130 E STATE HIGHWAY M35
Practice Address - Street 2:
Practice Address - City:GWINN
Practice Address - State:MI
Practice Address - Zip Code:49841-9159
Practice Address - Country:US
Practice Address - Phone:906-346-0104
Practice Address - Fax:906-346-6422
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist