| NPI | 1316643968 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH BACK Director Managed Care 616-401-4484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2023-02-06 |