Provider Demographics
NPI:1881970143
Name:CORSTANGE, RICHARD JAMES
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JAMES
Last Name:CORSTANGE
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 1:918 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1752
Mailing Address - Country:US
Mailing Address - Phone:269-382-8181
Mailing Address - Fax:269-382-6504
Practice Address - Street 1:918 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1752
Practice Address - Country:US
Practice Address - Phone:269-382-8181
Practice Address - Fax:269-382-6504
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist