Individual
JASON VERGOUWE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 391-1638
(616) 391-2958
Mailing address
124 LONETREE DR NW, SPARTA, MI 49345-8204
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302029197
MI
Other
Enumeration date
02/01/2007
Last updated
07/08/2007
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