Healthcare Provider Details

I. General information

NPI: 1992172712
Provider Name (Legal Business Name): ROBERTSON G ZUAH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 KALAMAZOO AVE SE STE 13
GRAND RAPIDS MI
49508-3673
US

IV. Provider business mailing address

5768 SUGARBERRY DR SE
KENTWOOD MI
49512-9413
US

V. Phone/Fax

Practice location:
  • Phone: 616-438-3474
  • Fax:
Mailing address:
  • Phone: 616-438-3474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302029530
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: