Organization
KENTWOOD PHARMACY LLC
Active
Parent organization
KENTWOOD PHARMACY LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
KENTWOOD PHARMACY LLC
Authorized official
MR. KIM MULDER (CEO)
(616) 827-9100
Entity
Organization
Contact information
Practice address
2026 BOSTON ST. SE, GRAND RAPIDS, MI 49506
(616) 452-9734
(616) 452-7255
Mailing address
2480 44TH ST SE, GRAND RAPIDS, MI 49512
(616) 827-9100
(616) 827-9116
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
5301009297
MI
Other
Enumeration date
03/24/2010
Last updated
03/24/2010
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