Organization
CHERRY STREET SERVICES, INC
Active
Parent organization
CHERRY STREET SERVICES, INC
Other names
Westside Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHERRY STREET SERVICES, INC
Authorized official
TASHA BLACKMON (CEO)
(616) 965-8200
Entity
Organization
Contact information
Practice address
669 STOCKING AVE NW, GRAND RAPIDS, MI 49504-5176
(616) 776-2226
Mailing address
669 STOCKING AVE NW, GRAND RAPIDS, MI 49504-5176
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5301013082
PHARMACY LICENSE
MI
01
—
5315237894
CONTROLLED SUBSTANCE LICENSE
MI
Enumeration date
11/21/2022
Last updated
02/24/2023
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