Individual
JONATHAN WYBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3181 WINANS STREET, GRAND RAPIDS, MI 49534-9526
(248) 345-6142
Mailing address
3181 WINANS STREET, GRAND RAPIDS, MI 49534
(248) 345-6142
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302038653
MI
Other
Enumeration date
11/19/2013
Last updated
11/19/2013
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