Healthcare Provider Details

I. General information

NPI: 1780748178
Provider Name (Legal Business Name): STEVEN PAUL VACHON R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JEFFERSON AVE SE CHCWM-LACKS PHARMACY
GRAND RAPIDS MI
49503-4502
US

IV. Provider business mailing address

6659 5 MILE RD NE
ADA MI
49301-9723
US

V. Phone/Fax

Practice location:
  • Phone: 616-752-5274
  • Fax: 616-752-5534
Mailing address:
  • Phone: 616-874-1031
  • Fax: 616-752-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302028412
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number5302028412
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: