Healthcare Provider Details

I. General information

NPI: 1881926038
Provider Name (Legal Business Name): JAMES G LAHNALA R PH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 N KENT MALL NE
GRAND RAPIDS MI
49525-1633
US

IV. Provider business mailing address

4111 N KENT MALL NE
GRAND RAPIDS MI
49525-1633
US

V. Phone/Fax

Practice location:
  • Phone: 616-364-6147
  • Fax: 616-364-6479
Mailing address:
  • Phone: 616-364-6147
  • Fax: 616-364-6479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302025993
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: