# KENTWOOD PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** KENTWOOD PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346419892
- **Authorized official:** JENNIFER BYNSKI (OPER MANG)
- **Authorized official phone:** (616) 581-7093

## Contact information

- **Practice address:** 2480 44TH ST SE, KENTWOOD, MI 49512-9090
- **Practice address phone:** (616) 827-9100
- **Practice address fax:** (616) 827-9116
- **Mailing address:** 2480 44TH ST SE, KENTWOOD, MI 49512-9090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 5301008811 | MI | Yes |

## Other

- **Enumeration date:** 02/28/2008
- **Last updated:** 10/15/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2370841 | OTHER ID NUMBER | — |