Healthcare Provider Details

I. General information

NPI: 1770623779
Provider Name (Legal Business Name): ELLEN LINDA VANSTEE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2560
US

IV. Provider business mailing address

3826 CHAMBERLAIN AVE SE
GRAND RAPIDS MI
49508-2612
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-1297
  • Fax: 616-391-9598
Mailing address:
  • Phone: 616-241-1537
  • Fax: 616-391-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302024980
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: