Healthcare Provider Details

I. General information

NPI: 1629293816
Provider Name (Legal Business Name): JOY VANREGENMORTER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 BOSTON ST SE
GRAND RAPIDS MI
49506-4160
US

IV. Provider business mailing address

1940 BLUFFVIEW DR SW
BYRON CENTER MI
49315-9367
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-7024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302032567
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: