Healthcare Provider Details

I. General information

NPI: 1326568296
Provider Name (Legal Business Name): SARAH ANN KAUFFMAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 DIVISION AVE S STE 1A
GRAND RAPIDS MI
49503-4501
US

IV. Provider business mailing address

360 DIVISION AVE S STE 1A
GRAND RAPIDS MI
49503-4501
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-1147
  • Fax: 616-685-1145
Mailing address:
  • Phone: 616-685-1147
  • Fax: 616-685-1145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302031876
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: