Healthcare Provider Details

I. General information

NPI: 1659598555
Provider Name (Legal Business Name): NORTH OTTAWA COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 SHELDON RD STE 104
GRAND HAVEN MI
49417-2480
US

IV. Provider business mailing address

1445 SHELDON RD STE 104
GRAND HAVEN MI
49417-2480
US

V. Phone/Fax

Practice location:
  • Phone: 616-842-5193
  • Fax: 616-842-0930
Mailing address:
  • Phone: 616-842-5193
  • Fax: 616-842-0930

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 Number5301008605
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY GERMAIN
Title or Position: PHARMACY MANAGER
Credential: PHARMD
Phone: 616-842-5193