Organization
KENTWOOD PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KIM MULDER (OWNER)
(616) 827-9100
Entity
Organization
Contact information
Practice address
6680 KALAMAZOO AVE SE, GRAND RAPIDS, MI 49508-7030
(616) 554-1964
(616) 554-3140
Mailing address
6680 KALAMAZOO AVENUE SE, GRAND RAPIDS, MI 49508
(616) 554-1964
(616) 554-3140
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5301007344
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200288790
—
IN
05
—
2362349
—
MI
Enumeration date
08/24/2006
Last updated
02/27/2008
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