Provider Demographics
NPI:1487164927
Name:BREGE, KRISTI KAE (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:KAE
Last Name:BREGE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 CENTRAL PARK WAY NE APT 104
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-3480
Mailing Address - Country:US
Mailing Address - Phone:989-306-2462
Mailing Address - Fax:
Practice Address - Street 1:842 S STATE ST
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2250
Practice Address - Country:US
Practice Address - Phone:231-796-8659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist