Provider Demographics
NPI:1023447240
Name:FETTES, ZACHARY (PHARMD RPH)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:
Last Name:FETTES
Suffix:
Gender:M
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 1:2916 TRAPPERS COVE TRL APT 2B
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-8499
Mailing Address - Country:US
Mailing Address - Phone:269-986-2005
Mailing Address - Fax:
Practice Address - Street 1:2055 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1706
Practice Address - Country:US
Practice Address - Phone:517-349-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist