# KENTWOOD PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kentwood Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760638019
- **Authorized official:** MARK DOWNER (ACCOUNTS PAYABLE)
- **Authorized official phone:** (616) 827-9100

## Contact information

- **Practice address:** 116 N MILL ST, SAINT LOUIS, MI 48880-1521
- **Practice address phone:** (989) 681-6633
- **Practice address fax:** (989) 681-6644
- **Mailing address:** 2480 44TH ST SE, KENTWOOD, MI 49512-9090
- **Mailing address phone:** (616) 827-9100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 5901008943 | MI | Yes |

## Other

- **Enumeration date:** 08/18/2008
- **Last updated:** 07/09/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2372263 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |