Healthcare Provider Details

I. General information

NPI: 1447533732
Provider Name (Legal Business Name): DAVID D POWERS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-2402
US

IV. Provider business mailing address

3610 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-2402
US

V. Phone/Fax

Practice location:
  • Phone: 616-365-1221
  • Fax: 616-364-9996
Mailing address:
  • Phone: 616-365-1221
  • Fax: 616-364-9996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302020372
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: