Organization
RED CROWN I, INC
Active
Other names
Red Crown Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC M GRAHAM RPH (PRESIDENT)
(269) 488-2630
Entity
Organization
Contact information
Practice address
4206 STADIUM DR, KALAMAZOO, MI 49008-1446
(269) 488-2630
(269) 488-2631
Mailing address
4206 STADIUM DR, KALAMAZOO, MI 49008-1446
(269) 488-2630
(269) 488-2631
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
5447160001
MI
3336C0003X
Community/Retail Pharmacy
Primary
5301008128
MI
3336L0003X
Long Term Care Pharmacy
5301008128
MI
3336S0011X
Specialty Pharmacy
5301008128
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2367008
—
MI
05
—
4833406
—
MI
Enumeration date
05/27/2005
Last updated
04/20/2008
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