Kelly Jo Thiede, RPH

NPI #1255682746 in Portage, Michigan

Provider Information

NPI Number: 1255682746
Entity Type: Individual
Name: Kelly Jo Thiede, RPH
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Pharmacist
Credential: RPH
Enumeration Date: Sep 25, 2012
Last Updated: Sep 25, 2012

Practice Location

Address: 6330 S WESTNEDGE AVE
City: Portage
State: Michigan
ZIP Code: 49002-3572
Phone: (269) 327-4508

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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