Healthcare Provider Details

I. General information

NPI: 1851055040
Provider Name (Legal Business Name): HANNAH CHAE PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 06/25/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 WALKER AVE NW
GRAND RAPIDS MI
49544-8422
US

IV. Provider business mailing address

5500 CLYDE PARK AVE SW
WYOMING MI
49509-6402
US

V. Phone/Fax

Practice location:
  • Phone: 616-745-1846
  • Fax:
Mailing address:
  • Phone: 616-530-7110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5351011682
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: