Healthcare Provider Details

I. General information

NPI: 1326484254
Provider Name (Legal Business Name): CAROL J. GEURINK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2013
Last Update Date: 05/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 LAKE MICHIGAN DR NW
GRAND RAPIDS MI
49504-5872
US

IV. Provider business mailing address

3003 64TH AVE
ZEELAND MI
49464-9663
US

V. Phone/Fax

Practice location:
  • Phone: 616-791-4777
  • Fax:
Mailing address:
  • Phone: 616-772-2590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302024360
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: