Healthcare Provider Details

I. General information

NPI: 1154944320
Provider Name (Legal Business Name): CEDAR SPRINGS PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14111 WHITE CREEK AVE NE STE 12
CEDAR SPRINGS MI
49319-8170
US

IV. Provider business mailing address

14111 WHITE CREEK AVE NE STE 12
CEDAR SPRINGS MI
49319-8170
US

V. Phone/Fax

Practice location:
  • Phone: 616-439-2779
  • Fax: 616-439-2552
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JODI MAKI
Title or Position: PHARMACIST/OWNER
Credential: R.PH., PHARM.D.
Phone: 616-439-2779