Organization
KENTWOOD PHARMACY
Active
Other names
Kentwood Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MARK DOWNER (ACCOUNTS PAYABLE)
(616) 827-9100
Entity
Organization
Contact information
Practice address
116 N MILL ST, SAINT LOUIS, MI 48880-1521
(989) 681-6633
(989) 681-6644
Mailing address
2480 44TH ST SE, KENTWOOD, MI 49512-9090
(616) 827-9100
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
5901008943
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2372263
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/18/2008
Last updated
07/09/2010
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