Healthcare Provider Details

I. General information

NPI: 1760920698
Provider Name (Legal Business Name): HEIDI CATHERINE THOMPSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI CATHERINE STULTZ-GRIFFEY PHARMD

II. Dates (important events)

Enumeration Date: 02/12/2017
Last Update Date: 04/19/2025
Certification Date: 04/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 DIVISION AVE S STE 1C
GRAND RAPIDS MI
49503-4501
US

IV. Provider business mailing address

2237 WESTOVER DR
IONIA MI
48846-2145
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-1100
  • Fax: 800-380-1226
Mailing address:
  • Phone: 517-260-0260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302044614
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: