Provider Demographics
NPI:1932244761
Name:KRONEMEYER, KYLE T (RPH)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:T
Last Name:KRONEMEYER
Suffix:
Gender:M
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:PO BOX 1507
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49204-1507
Mailing Address - Country:US
Mailing Address - Phone:517-788-6969
Mailing Address - Fax:
Practice Address - Street 1:290 W CARLETON RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-5034
Practice Address - Country:US
Practice Address - Phone:517-439-9409
Practice Address - Fax:517-439-0970
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302029608OtherMICH LICENSE NUMBER