Provider Demographics
NPI:1770643660
Name:BRIGGS, KENNETH C (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:C
Last Name:BRIGGS
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 1:4021 LOVE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8427
Mailing Address - Country:US
Mailing Address - Phone:517-764-5424
Mailing Address - Fax:517-764-5706
Practice Address - Street 1:900 E GANSON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1700
Practice Address - Country:US
Practice Address - Phone:517-787-3194
Practice Address - Fax:517-787-8005
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020119527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI53020119527OtherPHARMACIST