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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