Organization
JAI CHAMUNDA KALAMAZOO, INC.
Active
Organization
JAI CHAMUNDA KALAMAZOO, INC.
Active
Other names
Park Street Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MORGAN GRAHAM TATUM (OWNER)
(561) 373-0577
Entity
Organization
Contact information
Practice address
512 NORTH PARK STREET, KALAMAZOO, MI 49007
(269) 381-1888
(269) 382-6315
Mailing address
512 NORTH PARK STREET, KALAMAZOO, MI 49007
(269) 381-1888
(269) 382-6315
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301010761
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2156144
PK
—
Enumeration date
11/10/2015
Last updated
03/05/2019
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