| NPI | 1215106034 |
|---|---|
| Other Name | MEDISERV PHARMACY |
| Entity Type | Organization |
| Authorized Contact | RAYMOND GORDON DORHOUT Pres 616-340-8780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: MI 5301008816) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: MI 5301008816) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MI 5301008816) | |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: MI 5301008816) | |
| 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: MI 5301008816) | |
| 3336S0011X Pharmacy, Specialty Pharmacy (Licence: MI 5301008816) | |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2008-06-10 |