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Organization

MODEL DRUG STORE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. SHARON BETH FISHER RPH (OWNER)
(616) 392-4707
Entity
Organization

Contact information

Practice address
35 W 8TH ST, HOLLAND, MI 49423-3102
(616) 392-4707
(616) 392-2449
Mailing address
35 W 8TH ST, HOLLAND, MI 49423-3102
(616) 392-4707
(616) 392-2449

Taxonomy

Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301002043
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1697599
MI
01
2306303
NCPDP
Enumeration date
08/12/2006
Last updated
03/24/2009
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