Organization
KENTWOOD PHARMACY
Active
Other names
KENTWOOD PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER BYNSKI (OPER MANG)
(616) 581-7093
Entity
Organization
Contact information
Practice address
2480 44TH ST SE, KENTWOOD, MI 49512-9090
(616) 827-9100
(616) 827-9116
Mailing address
2480 44TH ST SE, KENTWOOD, MI 49512-9090
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336L0003X
Long Term Care Pharmacy
Primary
5301008811
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2370841
OTHER ID NUMBER
—
Enumeration date
02/28/2008
Last updated
10/15/2008
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