Healthcare Provider Details

I. General information

NPI: 1699829556
Provider Name (Legal Business Name): NORTHWEST SYNERGY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1693 BENZIE HWY
BENZONIA MI
49616-0060
US

IV. Provider business mailing address

1693 BENZIE HIGHWAY PO 60
BENZONIA MI
49616-0060
US

V. Phone/Fax

Practice location:
  • Phone: 231-882-4311
  • Fax: 231-882-9411
Mailing address:
  • Phone: 231-882-4311
  • Fax: 231-882-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS L GUILLARD
Title or Position: OWNER
Credential: RPH
Phone: 231-882-4311