Healthcare Provider Details

I. General information

NPI: 1609591908
Provider Name (Legal Business Name): CHLOE CASANAVE MASTERSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 68TH ST SW
GRAND RAPIDS MI
49548-7112
US

IV. Provider business mailing address

8 68TH ST SW
GRAND RAPIDS MI
49548-7112
US

V. Phone/Fax

Practice location:
  • Phone: 616-827-0270
  • Fax:
Mailing address:
  • Phone: 616-827-0270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5351010927
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: