Healthcare Provider Details

I. General information

NPI: 1396044004
Provider Name (Legal Business Name): JAMES D VANHULLE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E STATE ST
CASSOPOLIS MI
49031-1328
US

IV. Provider business mailing address

305 E STATE ST
CASSOPOLIS MI
49031-1328
US

V. Phone/Fax

Practice location:
  • Phone: 269-445-5369
  • Fax: 269-445-0702
Mailing address:
  • Phone: 269-445-5369
  • Fax: 269-445-0702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302025917
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: