Healthcare Provider Details

I. General information

NPI: 1124454095
Provider Name (Legal Business Name): PATRICIA ANN SMEELINK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 CASCADE RD SE WALGREENS
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

7606 ASPENWOOD DR SE
ADA MI
49301-9324
US

V. Phone/Fax

Practice location:
  • Phone: 616-957-8934
  • Fax:
Mailing address:
  • Phone: 616-822-4184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25020
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: