Kevin Dieckmann, PHARMD.
Individual provider Active NPI Pharmacist · Sandusky, MI
NPI 1669822110 · NPPES record last updated Jun 15, 2016
Key facts
- NPI
- 1669822110
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 5302028828 (MI)
- Practice address
- 655 W Sanilac Rd
Sandusky, MI 48471-9667 - Phone
- (810) 648-4247
- NPI assigned
- Jun 15, 2016
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302028828 | MI | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302028828 | MI | Yes |
Addresses
Primary practice location
655 W Sanilac Rd
Sandusky, MI 48471-9667
Mailing address
655 W Sanilac Rd
Sandusky, MI 48471-9667
Phone (810) 648-4247
Other providers in Sandusky, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.