Provider Demographics
NPI:1730478553
Name:SISSON, NATALIE RAE (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:RAE
Last Name:SISSON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12360 MCKINLEY RD
Mailing Address - Street 2:
Mailing Address - City:RODNEY
Mailing Address - State:MI
Mailing Address - Zip Code:49342-9701
Mailing Address - Country:US
Mailing Address - Phone:231-250-3241
Mailing Address - Fax:
Practice Address - Street 1:100 COVERED VILLAGE MALL
Practice Address - Street 2:
Practice Address - City:BELDING
Practice Address - State:MI
Practice Address - Zip Code:48809
Practice Address - Country:US
Practice Address - Phone:616-794-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist