Provider Demographics
NPI:1750986485
Name:KINSEY, CHARLES ALLEN
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ALLEN
Last Name:KINSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-0579
Mailing Address - Country:US
Mailing Address - Phone:989-846-0411
Mailing Address - Fax:989-846-0463
Practice Address - Street 1:533 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658-9531
Practice Address - Country:US
Practice Address - Phone:989-846-0411
Practice Address - Fax:989-846-0463
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist