# KENTWOOD PHARMACY

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

## Provider details

- **NPI number:** 1841446192
- **Authorized official:** LINDA MALINOWSKI (CONTROLLER)
- **Authorized official phone:** (616) 827-9100

## Contact information

- **Practice address:** 257 W WRIGHT AVE, SHEPHERD, MI 48883-2502
- **Practice address phone:** (616) 827-9100
- **Mailing address:** 2480 44TH ST SE, KENTWOOD, MI 49512-9090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 5301008951 | MI | Yes |

## Other

- **Enumeration date:** 08/18/2008
- **Last updated:** 09/02/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2372251 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |