Healthcare Provider Details

I. General information

NPI: 1669742136
Provider Name (Legal Business Name): PHARMD CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8191 S STATE RD
GOODRICH MI
48438-9723
US

IV. Provider business mailing address

PO BOX 547
GOODRICH MI
48438-0547
US

V. Phone/Fax

Practice location:
  • Phone: 810-636-2979
  • Fax: 810-636-2981
Mailing address:
  • Phone: 810-636-2980
  • Fax:

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 Number5301009826
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JASON CHON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 248-494-0332