Kentwood Pharmacy
Pharmacy, Long Term Care Pharmacy in Saint Louis, MI. Organization (NPI-2).
NPI number1760638019
StatusActive
Last updated in NPPESJul 9, 2010
Details
- NPI
- 1760638019
- Entity type
- Organization (NPI-2)
- Legal business name
- Kentwood Pharmacy
- Organization subpart
- No
- Enumeration date
- Aug 18, 2008
- Last updated
- Jul 9, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336L0003X | Pharmacy, Long Term Care Pharmacy | 5901008943 | MI | Yes |
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | – | – | |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – |
Other names
- Kentwood Pharmacy (Doing Business As)
Practice location
116 N Mill StSaint Louis, MI 48880-1521
Phone 989-681-6633 · Fax 989-681-6644
Mailing address
2480 44th St SeKentwood, MI 49512-9090
Phone 616-827-9100
Authorized official
Mark Downer
Accounts Payable
6168279100
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