Provider Demographics
NPI:1952906893
Name:KERWIN, MICHELLE ANN (RPH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:KERWIN
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 1:741 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3045
Mailing Address - Country:US
Mailing Address - Phone:312-567-9044
Mailing Address - Fax:312-567-9492
Practice Address - Street 1:741 W 31ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3045
Practice Address - Country:US
Practice Address - Phone:312-567-9044
Practice Address - Fax:312-567-9492
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051038462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist