Healthcare Provider Details

I. General information

NPI: 1356690960
Provider Name (Legal Business Name): MICHELLE A CRANE PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 28TH ST SE
GRAND RAPIDS MI
49512-2049
US

IV. Provider business mailing address

15224 144TH AVE
SPRING LAKE MI
49456-9290
US

V. Phone/Fax

Practice location:
  • Phone: 616-222-4890
  • Fax:
Mailing address:
  • Phone: 616-402-5892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number530204272
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: