Healthcare Provider Details

I. General information

NPI: 1689088049
Provider Name (Legal Business Name): NGA SAMANTHA ZHANG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 WILLOW SPGS NE
GRAND RAPIDS MI
49525-9518
US

IV. Provider business mailing address

3675 WILLOW SPGS NE
GRAND RAPIDS MI
49525-9518
US

V. Phone/Fax

Practice location:
  • Phone: 616-805-9686
  • Fax:
Mailing address:
  • Phone: 616-805-9686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302039492
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: