Organization
CHERRY STREET SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TASHA BLACKMON (CEO)
(616) 965-8215
Entity
Organization
Contact information
Practice address
100 CHERRY ST SE, GRAND RAPIDS, MI 49503-4526
(616) 965-8278
(616) 940-5805
Mailing address
100 CHERRY ST SE, GRAND RAPIDS, MI 49503-4526
(616) 965-8200
(616) 940-5805
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301009686
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2376146
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/02/2011
Last updated
04/20/2018
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