Provider Demographics
NPI:1679955025
Name:STERN, KADEN (PHARMD)
Entity type:Individual
Prefix:
First Name:KADEN
Middle Name:
Last Name:STERN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3757 PLAINFIELD AVE NE
Mailing Address - Street 2:PHARMACY
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-2403
Mailing Address - Country:US
Mailing Address - Phone:616-364-6211
Mailing Address - Fax:
Practice Address - Street 1:3757 PLAINFIELD AVE NE
Practice Address - Street 2:PHARMACY
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-2403
Practice Address - Country:US
Practice Address - Phone:616-364-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist