Provider Demographics
NPI:1831480490
Name:KRUMBACH, TERRENCE LEE (RPH)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:LEE
Last Name:KRUMBACH
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 1:4174 E QUICK RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MI
Mailing Address - Zip Code:48742-9726
Mailing Address - Country:US
Mailing Address - Phone:989-619-3161
Mailing Address - Fax:
Practice Address - Street 1:101 SOUTH MORENCI
Practice Address - Street 2:RITE AID DISCOUNT PHARMACY #1715
Practice Address - City:MIO
Practice Address - State:MI
Practice Address - Zip Code:48647
Practice Address - Country:US
Practice Address - Phone:989-826-3737
Practice Address - Fax:989-826-8967
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist