Healthcare Provider Details

I. General information

NPI: 1427877364
Provider Name (Legal Business Name): ZUAH PHARMACY WELLNESS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 KALAMAZOO AVE SE STE 13
GRAND RAPIDS MI
49508-3673
US

IV. Provider business mailing address

4301 KALAMAZOO AVE SE STE 13
GRAND RAPIDS MI
49508-3673
US

V. Phone/Fax

Practice location:
  • Phone: 616-259-9314
  • Fax: 616-226-6722
Mailing address:
  • Phone: 616-259-9314
  • Fax: 616-226-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERTSON G ZUAH
Title or Position: OWNER
Credential: RPH, BCMTMS
Phone: 616-438-3474