Organization
WANK ENTERPRISES
Active
Other names
EASTGATE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
WARD DUYSER (OWNER)
(616) 452-9734
Entity
Organization
Contact information
Practice address
2026 BOSTON ST SE, GRAND RAPIDS, MI 49506-4162
(616) 452-9734
(616) 452-7255
Mailing address
2026 BOSTON ST SE, GRAND RAPIDS, MI 49506-4162
(616) 452-9734
(616) 452-7255
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301002051
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0850160001
—
MI
01
—
2306187
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/18/2006
Last updated
10/13/2009
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