| NPI | 1962527010 |
|---|---|
| Doing Business As | WYOMING PARK COMPOUNDING PHARMACY |
| Entity Type | Organization |
| Authorized Contact | PAUL ALAN JENSEN Owner 616-532-2362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2020-08-22 |