Healthcare Provider Details

I. General information

NPI: 1003973561
Provider Name (Legal Business Name): PREVO'S FAMILY MARKETS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9375 CHERRY VALLEY AVE SE
CALEDONIA MI
49316-9506
US

IV. Provider business mailing address

SPARTAN PHARMACY NORTH 1527 MOMENTUM PLACE
CHICAGO IL
60689-5315
US

V. Phone/Fax

Practice location:
  • Phone: 616-891-7898
  • Fax: 616-891-8097
Mailing address:
  • Phone: 616-878-8584
  • Fax: 616-878-8850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008371
License Number StateMI

VIII. Authorized Official

Name: AMY ELLIS
Title or Position: DIRECTOR OF PHARMACY
Credential: RPH
Phone: 616-878-2848