Provider Demographics
NPI:1760780811
Name:KESEMEYER, RONALD MARK (RPH)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:MARK
Last Name:KESEMEYER
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 1:5426 HICKORY CIR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-2400
Mailing Address - Country:US
Mailing Address - Phone:810-230-8225
Mailing Address - Fax:
Practice Address - Street 1:4001 DAVISON RD
Practice Address - Street 2:STE A
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1401
Practice Address - Country:US
Practice Address - Phone:810-742-0217
Practice Address - Fax:810-744-9165
Is Sole Proprietor?:No
Enumeration Date:2011-03-13
Last Update Date:2011-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist