Provider Demographics
NPI:1962033076
Name:KAPKE, JUSTIN LEO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:LEO
Last Name:KAPKE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 S WHITTAKER ST
Mailing Address - Street 2:
Mailing Address - City:NEW BUFFALO
Mailing Address - State:MI
Mailing Address - Zip Code:49117-1763
Mailing Address - Country:US
Mailing Address - Phone:844-214-4446
Mailing Address - Fax:800-886-1521
Practice Address - Street 1:447 S WHITTAKER ST
Practice Address - Street 2:
Practice Address - City:NEW BUFFALO
Practice Address - State:MI
Practice Address - Zip Code:49117-1763
Practice Address - Country:US
Practice Address - Phone:844-214-4446
Practice Address - Fax:800-886-1521
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315213917183500000X
IL051.302601183500000X
MI5302412171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist