Organization
WEST MICHIGAN PHARMACY LLC
Active
Other names
West Michigan Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY GOOTE PHARMD (PHCY MGR,PIC,AO)
(231) 305-4095
Entity
Organization
Contact information
Practice address
20095 GILBERT RD, BIG RAPIDS, MI 49307-2365
(231) 305-4095
(231) 305-4094
Mailing address
20095 GILBERT RD, BIG RAPIDS, MI 49307-2365
(231) 305-4095
(231) 305-4094
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301010715
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149514
PK
—
Enumeration date
12/30/2014
Last updated
03/29/2017
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