Provider Demographics
NPI:1720699481
Name:KUZNER, LAURIE ANNE (RPH)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANNE
Last Name:KUZNER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 W OUTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2626
Mailing Address - Country:US
Mailing Address - Phone:313-966-2979
Mailing Address - Fax:313-736-4699
Practice Address - Street 1:6001 W OUTER DR STE 110
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2626
Practice Address - Country:US
Practice Address - Phone:313-966-2979
Practice Address - Fax:313-736-4699
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist