Healthcare Provider Details

I. General information

NPI: 1508844085
Provider Name (Legal Business Name): MICHELLE DENISE DOANE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2181 WEALTHY ST SE
GRAND RAPIDS MI
49506-3033
US

IV. Provider business mailing address

335 GLEN ARBOR DR NE
ROCKFORD MI
49341-1188
US

V. Phone/Fax

Practice location:
  • Phone: 616-451-3404
  • Fax: 616-451-3980
Mailing address:
  • Phone: 616-451-3404
  • Fax: 616-454-3980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302027385
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: