Individual
MITCHELL CAVANAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7782 20TH AVE, JENISON, MI 49428-8524
(616) 685-8700
Mailing address
200 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4502
(616) 685-5000
Taxonomy
Speciality
Code
Description
License number
State
1835P2201X
Ambulatory Care Pharmacist
Primary
5302412556
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5302412556
PHARMACIST LICENSE
MI
01
—
5315219725
CONTROLLED SUBSTANCE LICENSE
MI
Enumeration date
03/06/2019
Last updated
01/23/2025
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