| NPI | 1033489836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IAN NAGY Managed Care Gove RN Ment Contracting 616-249-6272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: IL 054017480) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: IL 054017480) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2021-09-07 |