Individual
FRED G MOMBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
1029 4 MILE RD NW, GRAND RAPIDS, MI 49544
(616) 784-4400
Mailing address
1029 4 MILE RD NW, GRAND RAPIDS, MI 49544
(616) 784-4400
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302024592
MI
Other
Enumeration date
04/13/2011
Last updated
04/13/2011
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