Organization
FULLER AVENUE PHARMACY
Active
Organization
FULLER AVENUE PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK ALMASSIAN (OWNER)
(616) 363-3889
Entity
Organization
Contact information
Practice address
2355 FULLER AVE NE, GRAND RAPIDS, MI 49505-4367
(616) 363-3889
Mailing address
2355 FULLER AVE NE, GRAND RAPIDS, MI 49505-4367
(616) 363-3889
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301002349
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5301002349
STATE LICENSE NUMBER
MI
Enumeration date
09/26/2006
Last updated
08/22/2020
Update your record
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