| NPI | 1164883450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON BEAUCH VP Of Pharmacy Merchandising 616-791-3169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: IN 60006565A) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: IN 60006565A) |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2016-06-23 |