Organization
HEIMDOLL HOLDINGS INC
Active
Other names
Rivertown Compounding Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MARY HEIM (RPH)
(616) 828-8565
Entity
Organization
Contact information
Practice address
4365 CANAL AVE SW STE N, SUITE N, GRANDVILLE, MI 49418-2697
(616) 723-9391
(616) 288-9870
Mailing address
4365 CANAL AVE SW STE N, SUITE N, GRANDVILLE, MI 49418-2697
(616) 723-9391
(616) 288-9870
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
5301011313
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2175505
PK
—
Enumeration date
01/25/2018
Last updated
01/25/2018
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