Provider Demographics
NPI:1831720507
Name:FITCH, DENIELLE KAY (PHARMD)
Entity type:Individual
Prefix:
First Name:DENIELLE
Middle Name:KAY
Last Name:FITCH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 HURON BEACH RD
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-8906
Mailing Address - Country:US
Mailing Address - Phone:989-590-7985
Mailing Address - Fax:
Practice Address - Street 1:2140 US HIGHWAY 23 S
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4542
Practice Address - Country:US
Practice Address - Phone:989-590-7985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist