Healthcare Provider Details

I. General information

NPI: 1861729675
Provider Name (Legal Business Name): GARY ALAN VACHON R.PH., M.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3876 E PARIS AVE SE SUITE 13
GRAND RAPIDS MI
49512-3974
US

IV. Provider business mailing address

1004 ALGER ST SE
GRAND RAPIDS MI
49507-3806
US

V. Phone/Fax

Practice location:
  • Phone: 616-777-0340
  • Fax: 616-855-0937
Mailing address:
  • Phone: 616-490-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302025473
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: