Healthcare Provider Details

I. General information

NPI: 1205762556
Provider Name (Legal Business Name): ERIK GOTBERG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2560
US

IV. Provider business mailing address

6845 LAKE BLUFF DR NE
COMSTOCK PARK MI
49321-8274
US

V. Phone/Fax

Practice location:
  • Phone: 616-916-2134
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302416495
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: