Individual
JASON JOHN BEAUCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
2929 WALKER AVE NW, GRAND RAPIDS, MI 49544-6402
(616) 791-3169
Mailing address
2929 WALKER AVE NW, GRAND RAPIDS, MI 49544-6402
(616) 791-3169
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302032411
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5302032411
PHARMACIST LICENSE
MI
Enumeration date
02/03/2014
Last updated
02/04/2014
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